Preamble

The House met at Eleven o'clock

PRAYERS

[Mr. SPEAKER in the Chair]

PETITION

Nurses (Pay)

Mr. Michael Shersby: With your permission, Mr. Speaker, and that of the House, I beg leave to present a petition from nurses employed at Hillingdon hospital and elsewhere in the London borough of Hillingdon. The petition reads as follows:
To the Honourable the Commons of Great Britain and Northern Ireland in Parliament assembled.
The Humble Petition of Hillingdon Centre of the Royal College of Nurses sheweth:

(1) the negotiation of senior staff salaries has been outstanding since 1974;
(2) the National Health Service functions only by the goodwill of staff: this is rapidly being eroded and morale has never been lower than at present;
(3) trained nurses are leaving for better-paid posts in industry and abroad, and, whilst the workload is constantly increasing, staffing levels are reaching a dangerously low level;
(4) hospitals are being run at night by nurses "moonlighting" to supplement their income: this causes lack of continuity and lowering of both the standards and quality of patient care;
(5) due to low rates of pay, many staff are obliged to live in subsidised accommodation, such as nurses' homes, many of which are below acceptable standards: Community Services and Area Health Authorities are unable to offer suitable accommodation;
(6) community staff who already subsidise the National Health Service and Area Management Service by using their own cars are taxed on their maintenance allowances: telephone and uniform allowances are similarly taxed;
(7) all meal breaks are in staff's own time although staff are frequently on call or disturbed during these times.

Wherefore your Petitioners humbly pray that your Honourable House will do all in its power to support the campaign for:

(1) the evolution of a continuous system whereby nurses and other members of the public service would receive adequate pay

awards in line with industry, thereby removing the need to ask for rises every three or four years;
(2) an immediate interim pay award;
(3) the abolition of differentials payable to all nurses engaged in psychiatric, geriatric and similar forms of nursing, and the increase of the basic salary for all nursing grades:
(4) extra duty payments to be brought into line with other disciplines, with, for example, time and a half for Saturday work and double time for work on Sundays and Bank Holidays;
(5) a review of night duty and on-call payments;
(6) the remuneration of Community Ward sisters and charge nurses for staying at Direct Patient Care (rather than going into nursing management) and the establishment of differentials for so doing; and
(7) the payment to learners of an educational grant, rather than their being funded, as at present, out of Area budget.

And your Petitioners, as in duty bound, will ever pray, etc.

To lie upon the Table.

NATIONAL LAND FUND

Mr. Speaker: Order. On Wednesday last the hon. Member for Daventry (Mr. Jones) raised a point of order in connection with the national land fund and the National Heritage Bill. I promised that in due course I would give him a ruling. My office has this morning been in touch with the hon. Gentleman. He expresses regret that he has a very important constituency engagement but is quite agreeable to the statement and the ruling being made this morning.
The hon. Member is correct in stating that at his request I advised him that there was no objection to his proceeding with his Private Member' Bill. This advice was given solely on the grounds of order. I have no views on the merits of the hon. Member' Bill, nor have I any power to accelerate or delay its progress through the House. Any hon. Member is entitled to object to a Private Member' Bill at the appropriate time, and the hon. Member' Bill must take its chance in the same way as Bills of other hon. Members.
On the question of the Treasury evidence to the Expenditure Committee, any witness has the right to give any evidence that he thinks fit. I have no responsibility whatsoever for it.
On the final point, as I have already written to the hon. Member, the House passed a resolution on 17 April 1946 authorising the issue from the Consolidated Fund to the national land fund of £50 million. It is that which influenced me in my opinion that no further charge was created by the hon. Member's Bill. How my opinion may affect the Treasury and its Ministers in their attitude to the Bill is entirely a matter for them to decide.

Mr. Fell: On a point of order, Mr. Speaker. At the beginning of your statement you said that the hon. Member concerned had a very important constituency engagement and that was why he was not in the House. The way in which our standards are declining is dreadful. The first duty of any hon. Member is in Parliament and nowhere else.

Mr. Speaker: In fairness to the hon. Member for Daventry (Mr. Jones), I should say that he did not know until this morning that I was making this statement. Any one of us might have been caught out in those circumstances. I must say that I am very surprised to see some hon. Members here on a Friday.

CEMETERIES AND CREMATORIA (INDUSTRIAL DISPUTE)

The Secretary of State for the Environment (Mr. Peter Shore): With permission, Mr. Speaker, I should like to make a statement about strike action against local authority cemeteries and crematoria.
Last Wednesday evening, I met the general secretaries and national officers of the unions concerned and conveyed to them the strong feelings of the House on this matter and repeated my earlier call for an immediate return to work. They agreed to pass on my call to their members through their regional and local officials.
Yesterday morning, on my instructions, my Department's regional director in the North-West met leaders of the three political parties in Liverpool, the Archbishop and Bishop of Liverpool and senior officials of the local authority to review the situation in the city and to consider with

them what assistance by the Government is needed.
They were unanimous in the view that the situation should and could be resolved at the local level. Following that meeting, as hon. Members will have seen from today's press reports, the men involved in the Liverpool disputes have agreed, on their union's advice, to return to work on Monday.
Mr. Speaker, I have already made known to the House my own deep concern that industrial action of this kind should cease. While welcoming the decision of the Liverpool workers to return to work, I am still concerned that similar industrial action is reported to be taking place elsewhere in the country. I hope that the strong wishes of the House will now be heeded by all those concerned and I hope, too, that any strike action affecting burial and cremation services will now cease.

Mr. Heseltine: The Secretary of State will understand that we welcome very much the news that the situation in Liverpool appears to have improved considerably, but is he aware that the position in Tameside is now intolerable? There are now 40 bodies remaining unburied, and since the assurances given by the Home Secretary on Monday and the Secretary of State on Wednesday that there should be action, precisely nothing has happened. The position in Tameside is that a Mr. Rawcliffe, who is a local representative of the union involved there, arranged a meeting this morning which was cancelled. As a consequence, the terms of settlement which had broadly proved acceptable in Liverpool have not even been put to the strikers in Tame-side. The local authority in Tameside feels that it has no choice but to ask contractors to come in and dig graves and provide operators for the crematoria. Will the Secretary of State say firmly and unequivocally that the Government will give all backing to that authority in the steps that it feels it must take? In view of the situation, will the Secretary of State come back to the House with another statement at the earliest opportunity next week?

Mr. Shore: I am always available to the House to answer questions and to make statements as they are thought appropriate. I am fully seized of the


importance of this matter. The problem at Tameside is serious. We gave first priority to the problem in Liverpool, which was the city most grievously affected. My understanding of Tame-side is that a meeting was to be called today, with a recommendation from the union to return to work. I am afraid that I have not got the detailed reports but I understand that there has been some further argument. I still believe and hope that there will be a meeting of the men concerned and that the right decision will be taken. I am fully aware of all our responsibilities in these matters but I think that in the circumstances it would be better to have that meeting before further action is contemplated.

Mr. Moonman: Does my right hon. Friend agree that this is a twofold problem? The first thing is to ensure that out of the abhorrence of the events of the last week the men should go back to work. We are glad that good sense has prevailed in Liverpool. However, the second problem remains. Will my right hon. Friend comment on the fact that an opportunity will be provided in Liverpool during the next few weeks, because the men will go out again on strike unless the issues of wages and conditions are resolved? We have a breathing space; we have not solved the problem.

Mr. Shore: Meaningful negotiations will begin shortly on the whole question of local authority manual workers' pay. These will cover the men who have been involved in these actions. I hope that there will be a satisfactory solution arising from those talks. But I do not believe that while the talks are continuing—and even if they were to run into difficulty—it would be right for this kind of action to be taken.

Mr. Graham Page: Is the Secretary of State aware that the union' advice to the Liverpool gravediggers and crematoria attendants and the acceptance of that advice is very welcome? However, is he aware that this applies only to the city of Liverpool, and up to half an hour ago, when I made inquiries, other metropolitan boroughs on Merseyside had not received any notification from the union or the strike committees that the gravediggers and the crematoria attendants would return. In the borough in which my constituency is situated, half the grave-

diggers and crematoria attendants have been out for a week, and according to the authority the other half will join them on Monday. Will the Secretary of State urge the unions to hold meetings with their strike committees and see that the advice accepted by Liverpool is accepted by those in the other metropolitan boroughs on Merseyside?

Mr. Shore: I am aware that boroughs adjacent to Liverpool and others in the North-West have had various actions taken by the men concerned this week. I shall see that this matter is taken up straight away.

Mr. Stephen Ross: Is the Secretary of State aware that we very much support the sentiments of the last paragraph of his statement and would like to express our thanks to the initiative of the police and Church leaders in Liverpool who have played a role in this? Will he give us an assurance that the backlog in Liverpool, which is very substantial, will be dealt with quickly and that there is no need for anyone to be buried at sea?

Mr. Shore: There may have been some misapprehensions about burial at sea. I think that it was an expression of one of the alternatives by the area medical officer, but I do not think that it was ever seriously contemplated. I believe that once the men are back there will be a steady and quick improvement in the situation.

Mr. Ogden: Will my right hon. Friend accept my thanks for the quiet but effective part that he played in the negotiations by encouraging Church leaders of all denominations on Merseyside to bring people together? If that can be continued, and my right hon. Friend's contacts with people continue, there is some hope of getting this kind of a settlement extended to other places. Regardless of the emotional impact, does he agree that our duties are more to the living in the hospitals than to the dead in the crematoria?

Mr. Shore: I believe that we have duties to both, but I think—while thanking my hon. Friend for his remarks—that in these very difficult matters the importance of responsible leadership—not only temporal and civic but spiritual leadership—is very important in the community. I am strongly convinced of the


basic feelings and the understandings of the men themselves and I believe that we must appeal to that deep sense in order to overcome this problem.

Mr. Steen: I should like to join with my hon. Friends in welcoming the announcement by the Secretary of State. There is one point that concerns me, which I mentioned yesterday to the Lord President. It relates to the problems faced by the relatives of deceased persons, who have had to be embalmed. These relatives have been put to considerable extra cost which has been not less than £18 and sometimes as much as £30. I wonder whether the Secretary of State could tell the House whether he will make special arrangements so that those relatives can claim a special grant to cover the cost of embalming?

Mr. Shore: I note the hon. Gentleman' point and am certainly prepared to consider, with the local authorities, any proposal on that point.

Mr. William Hamilton: May I revert to the point made by my hon. Friend the Member for Basildon (Mr. Moonman)? There is a very justified pay claim for low-paid workers, and the Government must surely be a little more flexible in negotiations within the next few weeks, but, however justified that claim may be, will my right hon. Friend put it on record that everybody in the House would condemn unconditionally the barbaric and inhumane behaviour of a tiny minority of people who have cast a slur on the fair name of trade unionism in this country?

Mr. Shore: I do not think that anyone has any doubt about the views of the House concerning the actions taken in this particular and most sensitive area. It is difficult to imagine any kind of civilised society that does not feel what I know the whole House feels on this question. On the question of the flexibility of the negotiations, I do not think that this is the moment to add to what I said in the House only two days ago. It is my strong wish and belief that the negotiations, which did not start when we expected them to, will start very soon.

Mr. Rees-Davies: With regard to what the Minister calls meaningful negotiations and what I call ongoing negotiations, will he take into account the possibility of

arbitration? The ambulance men have indicated to me that, so far as Kent is concerned, they would be very interested in the possibility of arbitration on their terms and conditions of service. Could the negotiations take into account the possibility that that method might be used in other areas of the National Health Service? Whether or not the Government retain the right in the long run to refuse the award, does not arbitration have a role to play in future negotiations?

Mr. Shore: It is not for me to make statements about the possible ways of proceeding with the difficult problems faced by the National Health Service, for which I am not the responsible Minister, but in terms of the local government manual workers' wage negotiations, this proposal has not, I think, been put by either side. What is being discussed is the role of comparability studies in the determination of pay.

Mr. Skinner: Does the Minister accept that a long-term solution to this problem cannot be achieved by waffle with archbishops and others of that kind, and that the real answer to the problem lies with him, as a representative of the Government, and others like him, negotiating with the trade unions involved on the basis of the £60-a-week minimum wage, not ony for those in Liverpool but for those workers in many other parts of the country currently engaged in a battle for a decent wage and the establishment of a little dignity?

Mr. Cormack: Dignity is the very last thing the hon. Member knows anything about.

Mr. Shore: I am very much aware of the need to find a satisfactory solution to what is undoubtedly a difficult pay problem, but I believe that we have to examine these things in greater detail and not simply to generalise on the basis of any particular figure as being the only possible way of resolving the situation. We must make progress this year and we must also find the machinery for the future which will ensure a fairer, more sensible and more rational approach to pay in the public sector. We are trying to do both.

Mr. Mellish: On a point of order, Mr. Speaker. May I ask for your good will and that of the House? For some years


now, in dockland, that derelict area about which we have heard a great deal in the past, there has been a project called "Tramell Crow". The scheme runs into many million of pounds, and it needed Government support. I am not defending that; I am simply stating the case.
As I understand it from the press this morning, the Government, having carefully considered the matter, have rejected the scheme. That decision will be of great concern to my local authority and to those who live and work in the area, because it involves many thousands of jobs.
My point of order is this: can my right hon. Friend the Secretary of State, who happens to be here, explain to me in some detail why it is that one reads in the press of a decision such as this and does not hear about it on the Floor of the House, when it is a matter of such great importance? Can my right hon. Friend be allowed to do that?

Mr. Speaker: Order. The right hon. Gentleman, as a former Chief Whip, seems to have learned every trick in the trade. The House will have heard what he said and so, of course, will people outside, but I am afraid that I have received no request from his right hon Friend to make a statement this morning.

Orders of the Day — MENTAL HEALTH (AMENDMENT) BILL

Order for Second Reading read.

11.28 a.m.

Mr. Geoffrey Pattie: I beg to move, That the Bill be now read a Second time.
This is the first occasion which the House has had to debate any aspect of mental health since the publication last September of the Government's long-awaited review of the Mental Health Act 1959. I wish to remind the House that an early-day motion tabled by the hon. Member for Basildon (Mr. Moonman) and supported by myself and over 70 hon. Members on both sides of the House stands on the Order Paper in the following terms:
That this House, recognising the difficulties at present faced within the mental health services, urges the Leader of the House to provide an early opportunity to debate the recent White Paper on Mental Health, as this would provide an opportunity to make the first significant changes since the original Act of 1959.
That motion remains the aim of all those in the House who take an interest in mental health and mental handicap. It is essential that time is found for a full debate on the White Paper as soon as possible, and in no way is this Second Reading debate to be seen as a substitute for a White Paper debate. I confess that some anxiety has been expressed in certain professional circles that a debate even on such a modest measure as that before the House today might deflect attention from the major national debate on the White Paper. I regard our debate today as a bonus, or even an hors d'oeuvre, an extra opportunity to focus attention on a subject which has not had a large share of parliamentary time.
I should make it clear that I am not attempting single-handed to amend the entire 1959 Act. The four proposals which comprise my Bill are each drawn from recommendations in the White Paper, and each in turn was included in the earlier consultative document. All seem to have widespread support.
The Bill represents an attempt to enact four small proposals which can be got


out of the way before the White Paper debate and any ensuing legislation. In view of the current parliamentary uncertainties, it is anyone's guess when such major legislation will be forthcoming.
Let me at this stage express my appreciation for the assistance and advice I have received in the preparation of the Bill from various quarters. I refer particularly to the Minister of State, Department of Health and Social Security and his Department, and the sponsors of the Bill from both sides of the House. I am also extremely gratified to have the support in the House today of my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith), who, as Minister of Health at the time, was the prime architect of the 1959 Act.
I think my right hon. and learned Friend knows that there is no implication in anything that I say today of fundamental criticism of that Act, but rather a desire to clarify and improve certain sections in the light of 10 years' experience of its working. The Act has worked remarkably well and if in the future I should be regarded as the handmaiden of a measure which stood the acid test of time as well as the 1959 Act has done, I should be well pleased.
Let me now describe the four proposals in the Bill. The first clause seeks to reduce by half the period of detention or guardianship under sections 26 and 60 of the 1959 Act. Clause 2 seeks to amend section 65 to make clear that the essential purpose of the restriction orders is to protect the public from serious harm. Clause 3 provides that where the restrictions are placed on a prisoner transferred to hospital on grounds of mental disorder, those restrictions should cease on what would have been the patient's earliest date of release had he remained in prison. The final proposal, in clause 4, repeals section 134, thereby removing control over the mail of mentally disordered patients who are not subject to detention.
Perhaps I may deal in detail with each of the proposals. The first concerns admissions to hospital under sections 26 and 60. The present position is that such admissions last for one year in the first instance, with the first renewal being for

a further year, the second renewal being for two years, and, thereafter, renewals taking place at two-yearly periods.
The consultative document reports that both the Royal College of Psychiatrists and MIND wish these periods of detention to be shortened, the Royal College saying that the two-year period
is too long, tends to be at variance with the liberty of the subject and is out of line with current advances in therapy.
The consultative document therefore suggested in chapter 3, paragraph 8 that the present period could be halved to six months on admission, followed by six months on first renewal, followed by one year. This suggestion became a firm proposal in the White Paper in chapter 2, paragraph 47 and has now been translated into clause 1 of the Bill.
Perhaps it might be of assistance to those hon. Members who are not closely familiar with the 1959 Act if I explain that although the admissions of which I have been speaking are carried out under sections 26 and 60, it is section 43 which specifies the actual period of detention, hence the necessity in clause 1 to amend section 43 if the periods of detention are to be halved. The House will appreciate that if this proposal is sustained the detention is not automatically terminated on elapse of the shorter period of time. Rather, the patient has twice the frequency of application to a mental health review tribunal.
Both the consultative document and the White Paper dealt with the question of the number of medical practitioners needed to prolong detention in that, whereas an application for admission has to be based on two independent medical recommendations, only one report from the responsible medical officer is needed to prolong detention.
It was felt, however, that after the patient's detention for a period in a hospital the family general practitioner would necessarily be out of touch with the patient and might also feel somewhat diffident about commenting on the consultant psychiatrist's opinion. The consultative document drew attention to the need to improve health authority monitoring arrangements in an endeavour to avoid renewals being made mechanically. The White Paper proposes a slight stiffening


in the requirements for renewals. Chapter 2, paragraph 46 says:
Improved monitoring together with a requirement of a likelihood of benefit from treatment and automatic referals to tribunals should, the Government considers, provide sufficient extra safeguards.
I am sure that it would be in order to mention here the importance of adequate safeguards for staff, together with a necessity to clarify the legal position where staff are confronted with a violent informal patient. In the event of my Bill receiving a Second Reading, I hope to consult both the relevant unions—the National Union of Public Employees and the Confederation of Health Service Employees. I have already invited them to participate and to supplement the advice I have so far received from the Royal College of Psychiatrists, MIND and the National Council of Community Health Councils.
It is stated in the financial memorandum to the Bill that the
reduction in periods of detention is likely as a consequence to increase the number of cases heard by Mental Health Review Tribunals
But the consultative document points out in chapter 8, paragraph 10 that too many tribunal members were appointed to begin with because of an overestimate of the number of cases expected. In the early years many of these tribunal members had very little to do, and even allowing for natural wastage over the years it is still reckoned that "perhaps a doubling" in the present work load could be undertaken. Throughout the country there are currently fewer than 1,000 cases a year.
Clause 1 (3) makes it clear that the new reduced periods apply only to existing patients on the first occasion on which authority for detention of guardianship expires or is reviewed. A patient undergoing his first renewal period is not disadvantaged. The worst off will be the patient who has just commenced a two-year renewal. I would be prepared to suggest in Committee an amendment to ameliorate the position of such patients, possibly by providing the review at the end of the first year. A patient already into the second year would continue unaffected.
The second proposal is to amend the wording of section 65 of the 1959 Act. After the words
for the protection of the public
shall be added "from serious harm." When the Royal Commission on mental illness and mental deficiency, otherwise known as the Percy committee, reported in 1957, it recommended in paragraph 519:
The fact that some patients are dangerous does not justify the application to all patients of the sort of compulsory powers and procedures which are necessary for these few patients.
It would seem from that and other comments in surrounding paragraphs that the Royal Commission envisaged a much narrower discretion being allowed to the courts than the wording of section 65 eventually provided.
That section reads:
Where a hospital order is made in respect of an offender by a court of assize or quarter sessions, and it appears to the court, having regard to the nature of the offence, the antecedents of the offender and the risk of his committing further offences if set at large, that it is necessary for the protection of the public so to do, the court may … further order that the offender shall be subject to the special restrictions set out in this section.
The Butler committee in its report of October 1975 criticised the tendency it had discovered from evidence given by the Home Office
that these orders are imposed in numbers of cases where their severity is not appropriate.
It went on to say:
There is no indication of the seriousness of the offences from which the public is intended to be protected by the restriction order provisions and some courts have evidently imposed restrictions on, for example, the petty recidivist because of the virtual certainty that he will persist in similar offences in the future.
Butler, in chapter 14, paragraph 24, refers again to the wording of the Royal Commission. The wording is:
a real danger to the commission of further serious offences.
Larry Gostin in his excellent two-volume work for MIND entitled "A Human Condition", cites in volume II, page 75:
Dr. Henry Rollin reviewed 127 abnormal offenders admitted to Horton hospital in 1961 and 1962, (16 per cent. of these were subject to restriction orders). In the following cases, it was difficult to see the need for a hospital order; one person was charged with stealing


a box of tomatoes from Covent Garden Market and another with the theft of a bottle of milk; another was charged with fraud involving a sum of £70. There were 51 offences against the public order mainly for 'being a suspected person', 'wandering abroad' or 'begging'. There were five sexual offences all involving indecent exposure.
There are many cases of so-called ordinary offenders receiving non-custodial sentences from the courts but restricted patients can spend many years in hospital after conviction for the same type of offence.
The Butler Committee found that in 1974 the average period of detention under a section 65 order was four and a half years, and detention could last for life.
I emphasise that although the proposals in this Bill are designed to assist patients, it is essential to bear in mind the rights of staff and the protection of the public. I have already indicated my wish to consult closely with the unions and the Royal College of Psychiatrists, but we must also have in mind the legitimate right of the public to protection.
As I am proposing in clause 2 the inclusion of the words in section 65 of the Act "from serious harm", it might assist the House if I outline what I have in mind by that wording.
Butler, in chapter 14, paragraph 24, makes it clear by exception that serious offences are homicide, attempted homicide, sexual offences, other offences against the person, and criminal damage.
Although the courts are now less eager to use section 65, Butler felt
that the wording of section 65(1) should be more tightly drawn to indicate its true intention, namely to protect the public from serious harm. A more restrictive wording of the section would help the courts in making the difficult decision whether it is appropriate to impose this severe form of control.
I have in mind that where there is a risk of violent behaviour or serious indecent assault—especially where children are concerned—or arson, the courts will continue to have discretion to consider imposing a section 65 order. I also have in mind the possibility of psychological injury as well as direct physical injury to the person.
The White Paper's proposal, which is now embodied in clause 2 of my Bill, can be found in chapter 5, paragraph 15.
The third proposal in the Bill involves the amendment of section 75(3) of the Act, which refers to the transfer of prisoners to hospital. As the law stands at present, a patient who is subject to a transfer direction under section 72, accompanied by a direction restricting discharge under section 74, remains subject to the restrictions until the expiration of his sentence. This is defined by the expiration of the period during which he would have been liable to have been detained in prison if the transfer direction had not been given. As there is no legal right to remission of sentence, any references to the period of detention must refer to the full sentence as passed by the court.
The White Paper explains, in chapter 5, paragraph 47, that the MIND proposal has its support. This proposal is that the restriction direction should cease to have effect on the date on which the patient could have been discharged from prison on remission of part of his sentence under the prison rules—that is, the earliest date of release. This proposal in clause 3 of my Bill means that a prisoner will henceforth be detained under civil powers only once he reaches his EDR.
Clause 4 provides for the repeal of section 134 of the Act and takes away any control over incoming and outgoing mail of informal mental patients. The argument for this proposal is well set out in chapter 8 of the White Paper. I quote from paragraph 5:
The question of security does not arise in relation to informal patients; and any justification for distinguishing between such patients and non-psychiatric patients (whose mail is not … subject to any restrictions) as regards withholding incoming correspondence, the possibility that they might receive letters which distress them or have a disruptive effect on their treatment. In practice, however, the pattern of modern communications—in, for instance, use of the telephone—is now such that withholding correspondence would be sealing oft only one form of communication and is unlikely to be effective in isolating informal patients from distressing or disruptive information. It is questionable, also, whether it is helpful to protect such patients, most of whom nowadays only stay in hospital for a few weeks or even days, from distressing news or conflicting viewpoints which they are in any event likely to encounter on discharge.
Hospital practice, also, has changed significantly. Shorter and repeated admissions, the marked increase in out-patient and day-patient treatment and the sharing of day hospital services by in-patients and day-patients have blurred the distinction between in-patients


and other patients. Increasingly, patients are being treated in psychiatric units of general hospitals, and freedom of movement of patients in these units, and in traditional psychiatric hospitals is now widespread. These factors make it difficult to exercise effective control over patients' correspondence.
Out-going letters from patients which might cause distress to recipients would seem to provide the main argument for considering a form of control. Psychiatric patients are of course not the only people who might send such letters, and there is no sound evidence that they display a propensity towards this. Indeed some patients, for example the mentally handicapped, may be considerably less capable of composing distressing or abusive correspondence than others. Concern on these grounds in relation to a small minority of patients does not seem sufficient to counter the arguments against depriving the vast majority of patients of a right to unhindered correspondence, nor to justify setting up elaborate machinery to overcome the practical difficulties of exercising effective control over the correspondence of informal patients.
I am bound to say that consultations that I have had with psychiatric social workers have borne out that they have no problems with this proposal.
I have brought this Bill to the House as part of a wider campaign to focus more attention in the growing numbers of the mentally ill and their problems. In a Health Service that is beset with problems and underfunding, the needs of the mentally ill and the mentally handicapped are always at the end of the queue. It is our responsibility, as Members of this House, to show our compassion, our understanding and our awareness of this group of our fellow-citizens who do not happen to be one of the big voting battalions in our society. I am confident that the House will grant them the modest measure of assistance which I claim is to be found for them in this Bill.

11.38 a.m.

Mr. Eric Moonman: I warmly support the way in which this Bill was presented by the hon. Member for Chertsey and Walton (Mr. Pattie). The hon. Gentleman is attempting to explore the weaknesses of the previous Act and is also trying, in a most creative way, to put right immediately some practical issues in the mental health service.
It may seem to many in the psychiatric hospitals service that the House of Commons has taken leave of its senses in debating the future of the service and

of the law when more immediate needs concerning treatment and care have become part of the industrial relations battle between the various groups.
Nevertheless, the hon. Gentleman is right to remind the House that whatever the present predicament in the psychiatric services, and whatever the tragic inconvenience being felt by patients and nursing staff today, it has to look beyond that situation, which we hope is temporary, to see how far the fundamental questions that he has raised with regard to the original Act and with regard to ways of improving the liberty of psychiatric patients can be taken up. Therefore, it is bold, not foolish, to do so. It is forward-looking and has the support of the all-party committee on mental health.
Not a week goes by but that we receive a telephone call, a letter or representations from social workers who bring to bear on us the importance of making the adjustments to the Act that we heard described. The cases range from the smaller items—the difficult, irritating cases to which the hon. Gentleman referred—to the questions of individual liberty, which were expressed by the hon. Member for the Isle of Wight (Mr. Ross) on behalf of his constituent, Diana Irons.
I do not wish to generalise on that case during the discussion on this Bill. However, the collage of tragic events associated with that girl and the fact that she is now in a state of turmoil in Broadmoor pinpoint the efforts made by the hon. Gentleman to stress the significance of liberty and correct justice for the psychiatric patient. Apart from what might happen in the way of a new Act of Parliament on mental health, if some of these clauses and the thinking behind them had been in operation, I guess that Diana Irons would not be in Broadmoor today. It is right to pay a tribute to the work of the hon. Gentleman.
Clause 1 seeks to halve the period of detention under sections 26 and 60 from one year to six months. It has been argued that it provides greater flexibility. However, it does something else. I am impressed with the argument that it would require greater monitoring by the area health authorities. No one who studies the psychiatric service can be satisfied that monitoring—the ongoing appraisal of the service—is being carried


out either competently or at all. Whether the area health authority or the general practitioner at a casebook level is involved, this is implied in this clause, which is well worthy of being introduced.
It was intended in the 1959 Act that the general practitioner would play a much greater role in the development of the after-care of the psychiatric patient on discharge from hospital. I recall a former Member of Parliament, a great battler for the psychiatric patient—the late Bessie Braddock—saying, after the Royal Commission and the Act, "We shall depend fundamentally on what the general practitioner does, not necessarily in his surgery, and on whether he is prepared to go into the patient's home on release from hospital."
I see little evidence that the general practitioner has given this matter priority. That is a generalisation. From all the evidence I have—and indeed through the all-party committee—we see good will from some GPs and from others a desire to learn more about how to cope with the psychiatric patient. However, in the main, this degree of monitoring has not taken place. This clause would enable monitoring to be carried out on those two levels. I hope that the clause and the sentiments of the hon. Gentleman will be taken up in a realistic way.
Clause 2 is a reflection of the White Paper. It embodies the intentions of it. It also sharpens up the references.
Clause 3 is intended to amend the law on restrictions on the discharge of prisoners and patients who are removed to hospitals. This means that we enter the area of civil powers. This always required improvement. Indeed, it was the basis of a number of cases recently before the committee.
The final clause, which sounds straight-forward and full of common sense, deals with the cause of a great deal of annoyance to patients and families. This method of communication has been overcome as a result of circumstances and other events. The question of providing protection to the family rests on a false assumption about the basis of the psychiatric service. If the family needs protection, it may well be that a wider understanding or case conference should take place with the

family if the family is so vulnerable that it must not be threatened by, for instance, mail. If there is an exchange of mail, this will be beneficial to the development and encouragement of the patient. Too often only one part of the problem is dealt with, namely, that of the patient who enters hospital, leaving the underlying difficulties in the home. If anyone imagines that the two parts of the problem could be isolated by preventing the mail or making it that much more difficult for the mail to get through, that shows a lack of understanding of what is likely to happen.
We are dealing with the question of putting something right that perhaps was not fully understood when the previous measure was passed. That is no criticism of those who produced the Act. It is a reflection of change, social desires and the understanding of what we have experienced in Parliament, the social work agencies, the hospitals and the psychiatric profession.
We must recognise that part of the case for the Bill is that we are much more aware of the problems. That is the reason for the Bill. Therefore, I am pleased to be a sponsor. We are much more aware of the power and force of the case for the Bill.
The hon. Gentleman said that there were no votes for the psychiatric. I do not accept that. To put it crudely, when we think of the sheer numbers of people involved we realise that there are certainly voices there. People are desperately anxious about what happens to family and friends when they go into psychiatric hospitals for treatment. This is no longer a minor matter. Each year in England 24 million working days are lost by people suffering from mental ill health. Five million people consult their GPs about mental health problems and are referred to specialist psychiatric services in England each year. In England and Wales 88,000 hospital beds are devoted to the care of mentally ill patients and 51,000 beds to cases of mental handicap.
That sounds to me as though we are putting forward a Bill which has wide ramifications in a large part of society. One woman in six and one man in nine are treated for psychiatric disorders at some stage in their lives. The hon. Gentleman, in his modest way, perhaps did not give


sufficient impact to that number and the great scale of the operation. According to a recent conservative estimate, one-fifth of those seen by GPs in practice suffer predominantly from psychiatric disorders.
I stress the importance of clause I to the role of the GP. I do not believe that it is enough for the GP merely to provide a prescription. There must be a greater and closer relationship with the other people who provide help in the community.
The need for the Bill becomes greater when we realise that in the 1970s the staff of mental hospitals have increasingly refused to accept difficult patients whom the courts wanted to send to them. I refer to the seriously disturbed patients who, three decades ago, would have been given asylum in our mental hospitals. Today they are denied it, not because they are dangerous but because they are difficult, unco-operative, uncontrolled or unsocial, drink, take drugs, upset other patients, or break the rules of the institution.
In a hospital with open doors those patients are more awkward to handle, and as hospital staff increasingly turn them away the hospital skill at handling such disturbed patients is disappearing. Some people had optimistically hoped that the special secure units which the 14 health regions were instructed to set up would solve the problem. That is another story: there have been real difficulties in getting that system into operation.
Finally, the Bill does not lessen the importance of having a new mental health Bill. This will come. The present Bill is an attempt to improve on what has already been done.
Reflecting on the provisions of the Bill and on what yet needs to be done to help to safeguard the interests of the mentally sick and the mentally handicapped in our society, I believe that we have started to bring to the attention of the House and the public the fact that, by showing that these modifications are so urgently needed, we have done no more than make it clear that the day cannot be long off when a full-scale Bill will come before the House to ensure that so many of the things that we have learned and need to improve upon from the original Act will at last be achieved. I warmly support the Bill.

12.1 p.m.

Sir Derek Walker-Smith: It is 20 years, almost to the day, since I moved the Second Reading of what is now the Mental Health Act. I should like to start by expressing my warm appreciation for the kind and characteristically generous references of my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) to that Act and to the part that I was privileged to play in placing it upon the statute book.
I should like also to express my pleasure at the fact that the Minister of State, the right hon. Member for Lewisham, East (Mr. Moyle), is on the Front Bench to reply to this debate—more particularly because his father, Arthur Moyle, who was so dear and respected a friend of mine, played a notable part from the Opposition Benches in the proceedings on the then Bill.
The Mental Health Act 1959 is a truly massive Act, comprising 154 sections and 8 schedules. It repealed 15 Acts in whole and 37 in part. It substituted for the intricate and idiosyncratic mosaic of the old law a new and comprehensive code, simpler to understand and apply and in line with contemporary thinking and social and medical advance.
On Third Reading of that Bill, the late Mr. Sorensen, a very good and respected Member of those days, said:
… for all time … the Bill will no doubt he known as the Walker-Smith Bill."—[Official Report, 6 May 1959; Vol. 605, c. 464.]
He was a false prophet: it is not so known. The haibt of calling Acts after the names of the Ministers who sponsor them has fallen into desuetude. I think that the last was probably the Butler Act—the Education Act of 1944—but even that is rarely referred to today in that way.
Nevertheless, I take a not wholly inappropriate pride not in any modest contribution that I was privileged to make but in the Act itself, product as it was of the collective widsom and experience of many. I am proud that it has been thought to require so little amendment over the two decades of its operation and that such amendment as it has received so far is mainly of a procedural or consequential nature.
But nothing is perfect, of course, and that does not mean that the Act does


not require and should not receive, like all other legislation, continuous surveillance with a view to achieving improvement in its content and operation. It is of course receiving such scrutiny, the latest manifestation being the White Paper to which reference has been made.
It is very much to the credit of my hon. Friend the Member for Chertsey and Walton that he has given to the Act and its workings such careful and conscientious scrutiny; that he has used his good fortune in the ballot to seek an improvement of the Act; that he has identified respects in which further advance in the liberalisation of the law can be made without jeopardy to the public interest; and, of course, that he has given so lucid and persuasive an exposition of his Bill. I hope that the Bill speedily becomes law and that, contrary to the trend to which I have just referred, it becomes known as the Pattie Act.
A satisfactory structure of mental health law, of its nature, must contain checks and balances. In particular, there are three main considerations which can sometimes be in conflict—the therapy of the patient, the liberty of the subject and the protection of the community. All three of those basic considerations and the necessity to reconcile them apply in those sections of the Mental Health Act which the Bill seeks to amend and improve.
I refer in particular to section 43, which clause 1 seeks to amend and which is concerned with the duration of authority for detention or guardianship and the discharge of patients. The philosophy underlying the 1959 Act was that as much treatment as possible should be given on an informal and voluntary basis and that there should be provision for that unfortunately inevitable residual category of cases where compulsion is necessary in the interests either of society as a whole or of the patients themselves.
Section 43 reflects that philosophy in its approach to the question of detention. It marked two significant advances on the old law. First, it introduced improved renewal procedures for compulsorily detained patients, that is to say, a review at the end of the first, second and fourth years and thereafter at two-yearly intervals if the detention should be required that long. Those shorter periods were substituted for the previous periods of

review at the end of the first, second and seventh years and thereafter at five-yearly intervals, with an additional review for the mentally ill, as distinct from the mentally handicapped, at the end of the fourth year.
Secondly, whereas this renewal procedure was an important improvement by way of degree, the second advance constituted a difference in kind. That was the introduction of an appeal to a mental health tribunal. The setting up of those tribunals and the conferring on the patient of the right of appeal to them was an innovation of the 1959 Act. It was a new concept of considerable value which time and experience have justified—the appeal to a mixed tribunal comprising medical men, lawyers and laymen, presided over by a lawyer and constituted on a regional basis.
The Bill is concerned to improve these procedures by further reducing the periods of review to six months and one year in place of the one-year and two-year periods in the Act, and leaving intact, of course, the right of appeal to the tribunal. Experience to date justifies this further advance and it is certainly to be welcomed.
I need not refer in specific detail to the other proposals described by my hon. Friend and by the hon. Member for Billericay (Mr. Moonman), who takes such a close and constructive part in mental health matters. Sections 65 and 75, the subject matter respectively of clauses 2 and 3, are basically Home Office concerns more than those of the Department of Health and Social Security.
I conclude by expressing the appreciation which I am sure we all feel to my hon. Friend for his constructive initiative in this context, and join him in the hope that the White Paper will be debated so that the whole subject of mental health may be reviewed and the whole working of the Act considered, with a view to its further improvement where necessary. Meanwhile, I invite the House to accord a warm welcome to the Bill.

12.10 p.m.

Mr. Christopher Price: I congratulate the hon. Member for Chertsey and Walton (Mr. Pattie) on bringing in the Bill and doing what I believe to be the really appropriate task which the Private Member's ballot


affords Members of Parliament. That is to find some area where one can get all-party and ministerial agreement to put forward reforms which there would not be time to put forward in Government time.
I also welcome the fact that the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) continues to take an interest in his child, as it were. But I think that there is now a fourth consideration to add to the three that the right hon. and learned Gentleman talked about, which are therapy of the patient, the liberty of the patient and the protection of the community. I think that the rights and welfare of staff in psychiatric hospitals are now a very important fourth aspect which has been rather ignored in the past and must be taken into account now. It is in that context, and in the context of the hon. Gentleman's coming discussions with the Confederation of Health Service Employees and the National Union of Public Employees and other institutions, that I want to speak.

Sir Derek Walker-Smith: I think that we would all accept the hon. Gentleman's fourth consideration as an addition to the three basic considerations that I mentioned. I did not refer to it because it is not specifically the subject of legislation in the same sense. But I accept what the hon. Gentleman says.

Mr. Price: I take the point, but I feel that this aspect may increasingly have to be the subject of legislation.
I think that the Mental Health Act 1959 has stood the test of time extremely well. Many of its provisions have not had to be used at all. Almost the biggest section of the Act deals with what happens if a Member of this House becomes incapable of carrying on his duties and with the number of occasions when one has to bring in the president of the Royal College of Psychiatrists before such a Member is finally asked to leave. That provision has not been used yet, and I hope that it will not be. But there is an enormous protection in the Act for that sort of patient, and I think that this modest Bill will give a little more protection to some of the rather more humble patients who form the mass of the people in our psychiatric hospitals.
I am glad that the hon. Gentleman is to have talks with NUPE and COHSE. A new situation is developing amongst staff in psychiatric hospitals in relation to their rights, a situation for which the Department has been at least partly responsible. I do not blame my right hon. Friend the present Minister of State, because it took place before his time. But when the Department issued instructions some years ago about how staff should deal with violent patients it made the serious mistake of consulting the Royal College of Nursing but of forgetting to consult properly COHSE and NUPE. That situation has been put right now, but the incident rankles with COHSE, whose members make up the vast proportion of those workers in the psychiatric wards who bear the brunt of the work to be done. I hope that that sort of incident will not occur again.
When the hon. Gentleman has those discussions, various points will come up, and one of them will be the problem of increased "sectioning". The aim of the 1959 Act was to have as many informal patients as possible and as few "section" patients as possible. It may be that we have gone a little too far. Some of the complaints coming forward about informal patients being detained or given medication against their will may arise because there is such a reluctance to put patients "under section" so that perhaps patients who ought to be "under section" are not being treated in that way.
It is important for patients to know exactly where they stand and what their rights are, and it is also important not to allow that sort of half-way house to grow in our psychiatric hospitals, with patients who are theoretically informal but are actually subject to a great number of restrictions. If we were to see the proportion of patients "under section" rising a little, I do not think that that would be anything to worry about particularly.

Mr. Pattie: The hon. Gentleman is shrewdly pointing to one almost concealed element in the informal category, which is those who are "invited" to go in on an informal basis, on the clear understanding that otherwise they will be "sectioned", and there is a certain latitude in the course of treatment allowed


on that basis. The hon. Gentleman's point is well taken.

Mr. Price: I am sure that the staff will want to discuss this with the hon. Gentleman because they, too, want to know where they stand with patients. It is just as hard on the staff as on the patients if they do not know what their rights are.
Another point which I am sure will arise in the discussions with COHSE and NUPE, and which the White Paper discussed extensively but which is perhaps unamenable to legislation, is the whole problem of medication. I never lose an opportunity to raise this matter because I believe that we should pay more attention to it. Perhaps some hon. Members saw the programme "Tonight" on television last night. It referred not to hospitals but to the prison service and the volume of medication of the kinds used generally in psychiatric hospitals—such as chlorpromazine and largactil—which is flowing into our prison population.
This is a problem over which nursing staff—sometimes quite junior staff and nursing assistants—are put in a difficult position. The doctor may prescribe medication, sometimes for a reluctant patient, and once again the staff in the hospitals want to know exactly where they are, what their rights are and what their duties are. If there is anything that the hon. Gentleman can do after his discussions to clear up their position, he will be doing a service not only to the staff but to the patients, because all the reports that we have had about abuses in psychiatric hospitals—the most recent one near my constituency being at St. Augustine's, in Canterbury—display a quite widespread misunderstanding at various levels in the hospitals of what people's rights are.
I am glad that the Bill goes a little way to improving the rights of formal patients to go to a mental health review tribunal. The more we can do to make clear what formal "section" patients in our hospitals are allowed to do and what they are not allowed to do, the better.
Parliament and the country have deceived themselves in their approach to mental health since the 1959 Act by saying that their aim is to return as many

patients as possible to the community, thus emptying the hospitals and keeping patients there only for the short time when they need treatment. However, I applaud the sentiment and believe that it is right.
The community does not make available the resources to cope with the difficult problem of community care for patients. I believe that both major parties bear guilt in that regard. Far too many people believe that community care is a cheap alternative. It should not be Patients should be returned to the community not because they need less care than in hospital but because it is better for them to regain more easily their dignity and health within the community. The community then becomes used to the fact that patients should not be shut away in a far-off asylum and that they have a great deal to contribute.
We want patients to return to the community, but time and again, when arrangements are made for them to be discharged from hospital no proper facilities are provided. I believe that those who say that we have gone too far in this respect are justified in saying that we push patients out of hospital without finding anywhere for them to go.
However, having made those general remarks, I support the elements in the Bill upon which the hon. Gentleman has obtained Government agreement. I wish that the Bill was as thick as the White Paper. There is much more that could be included in the Bill, but, as far as it goes, it should be welcomed by hon. Members on both sides of the House. I hope that it passes speedily through both Houses and becomes legislation before any untoward accident occurs to this place.

12.23 p.m.

Mr. Charles Irving: I join other right hon. and hon. Members in congratulating my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) on the compassionate way in which he presented the Bill. While I agree with much of what was said by the hon. Member for Lewisham, West (Mr. Price), I believe that a Bill is not necessarily good because it is thick. There are plenty of thick things around which would be better if they were thinner. I believe that the concise way in which the points are made in the Bill illustrates


the urgency of the problems in psychiatric and mental hospitals.
I welcome the Bill on two main grounds. First, it seeks to improve the position of patients undergoing treatment in psychiatric hospitals. I believe that is important at personal and individual levels. Secondly, it enlarges the rights and freedoms of a disadvantaged group, and that is of importance and benefit to all of us who live in a society where bureaucracy and administrative convenience present an unthinking threat to liberty.
It is vital at a time when human rights are high on the agenda of international politics that we should pay particular attention to the plight of involuntary psychiatric patients. I have not heard anyone suggest that psychiatry in this country has been subverted to the ends of political control, but our ability to draw attention to such abuses elsewhere must rest on the knowledge that we are acting to reduce to a minimum any needless restriction on the rights of even the most disordered members of the community. Therefore, I am pleased to support a Bill that moves in that direction.
Clause 1 effectively halves the period for which patients may be detained involuntarily before being able to challenge their detention. To put it the other way, their opportunities for appeal against continued detention are doubled. I hope that the Bill will not be seen as the last word on the issues that it affects and that the clause is a step towards the establishment of an open right of appeal. I would need persuading that such a system would lead to a significant level of abuse. I believe that it will contribute powerfully to the atmosphere that the Bill aims to promote.
Clause 2 addresses itself to the grounds on which Crown courts impose restriction orders on offenders committed to hospitals under section 60 of the Mental Health Act 1959.
A great scandal of our penal system is the number of people languishing in prison who are suffering from mental disorders that warrant detention for mental hospital treatment but for whom no beds can be found. Prison medical officers have estimated that on 30 June last year nearly 600 such people were in the prisons of England and Wales.
The 1976 report on the work of the prison department said:
Apart from the inhumane aspects of committing mentally disordered offenders to prisons and borstals, it is not possible to provide many of these unfortunates with the medical and nursing care that their condition requires.
No Member can fail to be acutely aware and disturbed by the overcrowding in our prisons. If the system were changed—the Bill will help that—it would be possible to relieve prisons of people who should not be there under any circumstances but who should be treated in hospital.
Largely, the solutions to this tragic problem, for example, the establishment of secure hospital units, as recommended by the Butler committee, are outside the scope of the Bill. However, by tightening the criteria for imposing restriction orders on mentally abnormal offenders, the Bill will help to reduce the reluctance of some hospitals to take such men and women.
The White Paper on the review of the Mental Health Act 1959 pointed out that
The problem is sometimes increased when the court has added a restriction order under section 65. Some doctors feel that their hands are too much tied by thee restrictions, the effect of which is to require them to seek the Home Secretary's consent before allowing a patient out of hospital for any period or discharging or transferring him; it can also lead to a situation where they may have to continue to take responsibility for a patient for whom they feel they can offer no further treatment.
The Bill echoes the proposals of the Butler committee, which recommended that the law be amended to indicate that the purpose of a restriction order is to protect the public from serious harm. That is perfectly correct. But the committee had evidence from the Home Office demonstrating that these orders are sometimes imposed in cases where their severity is clearly inappropriate. For example, there have been instances of restriction orders being made on offenders convicted of frequenting, soliciting, disorderly behaviour, shoplifting, petty theft and drunkenness.
It is hardly surprising, therefore, that the White Paper agreed that
There can be little doubt that restriction orders have been imposed on occasions where they are not really justified by the nature of the offence or by the offender's previous criminal and medical history.


The Bill would help to limit restriction orders to genuinely serious cases in line with the original intentions of the Mental Health Act.
Lastly, I should like to comment on the withholding of mail from informal patients. By repealing section 134 of the Mental Health Act, which enables mail to be withheld from informal patients, the Bill would bring the position of these patients into line with that of non-psychiatric patients. The security considerations that justify control over the correspondence of some serious offender patients do not arise in the case of voluntary patients. The only possible argument for withholding their mail is a concern that they may receive distressing letters which would have a disruptive effect on their treatment.
However, as the White Paper pointed out,
The pattern of modern communication—in, for instance, the use of the telephone—is now such that withholding correspondence would be sealing off only one form of communication and is unlikely to be effective in isolating patients from distressing and disruptive information. It is questionable also whether it is helpful to protect such patients, most of whom nowadays only stay in hospital for a few months or even days.
It is worth bearing in mind that in Northern Ireland, for instance, there is no provision for withholding patients' private correspondence, and that does not seem to have given rise to any special problems.
Moreover, by bringing the position into line with that of non-psychiatric patients, the Bill would help in a small way to reduce some of the stigma associated with admittance to a mental hospital.
I am very happy to support these proposals.

12.34 p.m.

Mr. Robin Hodgson: I join in the general congratulations to my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) on the Bill which he has introduced today.
Most hon. Members who have spoken in the debate have concentrated on the valuable way in which it would help to ease restrictions on mental patients and improve their civil rights in the broadest sense. I am not an expert on mental health to the same degree as my hon. Friend or, indeed, the hon. Member for

Basildon (Mr. Moonman), both of whom have taken a great interest in these matters. Therefore, the few remarks that I wish to make are more in the form of a request for further illumination than specific criticisms of the Bill.
My first concern is the effect that the provisions in the Bill may have on those who are not committed to mental hospitals. I am thinking of the unfortunates in our society—the homeless, the vagrants and the alcoholics—who live in a twilight world who have nowhere to go and have no future ahead of them.
I have been greatly impressed, when looking at various reports, by the relationship between mental illness and people in that condition. A study in Birmingham of the admittance of homeless people to hospital indicated that 75 per cent. had previously been in mental hospitals.
If we make it more difficult for people to be committed for treatment and provide that they are committed for shorter periods, is there not a risk that society, through the courts, will wish to wash its hands all the more readily of these unfortunates, in that it will be said "It is all very well committing these people, but, because the period of committal is so short, the possibility of being able to carry out effective treatment or undertaking any remedial action is very much reduced"? I therefore question whether, if we shorten the period of detention too much, the courts will feel that it is not worth while committing such a person in the first place. Therefore, we shall be unable to help the dross of society, about whom we must all have great anxiety.

Mr. Pattie: It is important not to confuse two of the Bill's provisions. Clause 1 proposes that the period of detention of people undergoing courses of treatment should be reduced by half. That is for the obvious reason that they will have twice the oportunities of having their cases reviewed by a tribunal than is the position now. With regard to the unfortunates—the vagrants and so on, described by my hon. Friend—I hope that these provisions will force society to say" If we cannot commit these people to some kind of limbo, what are we to do with them?" I think that society will have to address itself to the problem in that way.

Mr. Hodgson: I am delighted to hear that that is what my hon. Friend hopes to achieve. I am sure that all hon. Members hope that that aim will be achieved as a product of this measure.
I am concerned about the definition of "serious harm" to which my hon. Friend referred in his introductory remarks. So far, most hon. Members, with the exception of my hon. Friend, have referred to "serious harm" in physical terms. In some cases in my constituency "harm" has taken a different route. I am thinking of two separate cases. I come back to the vagrant or semi-vagrant who wanders around the community, existing in shops and libraries, because those are the only places which are warm and comfortable, and causing a great deal of nuisance, though not of an offensive kind, in public and semi-public places. Perhaps that is not an insurmountable problem.
More important are the offensive acts of harm, though not of a physical nature. In one case in my constituency, a mentally disturbed person visited old people's bungalows at night, rattled windows and doors and pressed his face upon the windows. That did not cause any serious harm. I do not think that he had any evil physical intent against the old people in those bungalows. However, it was very frightening for elderly people to find a strange face peering through their windows at half-past two in the morning.
I hope that in Committee further discussion will take place of the definition of "serious harm". I think that there is a psychological aspect to it for some members of society, particularly the elderly, who are less able than others to protect themselves.
My final point concerns the effect on public opinion. I do not know how fast public opinion is moving with regard to public disclosure, discussion and treatment of the mentally ill. I fear that it is not moving ahead as fast as many of us would wish.
My hon. Friend the Member for Chertsey and Walton described his measure as an hors d'oeuvre—I think that was the phrase he used—and a prelude to a larger and more detailed review of the Mental Health Act 1959. If we pass this measure—as indeed I hope we shall—and some nasty and highly publicised case arises out

of one of the measure that my hon. Friend has put in the Bill, there is a danger that this might set back public opinion and cause a reaction against the wider and broader review that we hope will soon take place. I have, therefore, some slight doubts in my mind.
If by ill chance—and it would be ill chance—as a result of this worthwhile measure some highly publicised case appeared in the News of the World—a newspaper with enormous national circulation—that could lead to many hon. Members receiving lots of letters from constituents asking them to make sure, when the wider review takes place, not to remove too many restrictions. This would set back the cause of the mentally ill which is so admirably advanced by this Bill.
What I think is certain is that public opinion about mental health will advance only if it is educated and informed. I am sure that an excellent by-product of my hon. Friend's measure will be to encourage wider discussion of the problems of the mentally handicapped, and the reporting of today's debate will take the issues into the minds of people who, until now, have not considered these matters. It is because of this practical political advantage, as well as the humanitarian aspects of the Bill, that I am pleased to support it.

12.41 p.m.

Mr. Tom Litterick: I take great pleasure in welcoming this Bill, as other Members of this House have done. As with the hon. Member for Walsall, North (Mr. Hodgson), my principal reason for doing so is that the Bill gives the House yet another opportunity to communicate to the public the difficult, sensitive subject of mental health and mental ill health, in an attempt to come to grips with the numerous social hang-ups that surround the subject. I have a constituency interest in that I have more than my fair share of institutions that handle people in various stages of treatment for mental disorder and mental disability of various kinds. I shall refer briefly to that later.
The idea of a Bill that enhances the rights of people is, as I think the hon. Member for Cheltenham (Mr. Irving) said, quite rightly, one that no one here is likely to contest. However, I am quite


sure, as the hon. Member for Walsall, North said, that somebody in the Sunday press will do a shock horror story in connection with the Bill. I hope that any hon. Member who gets a shock horror reaction from the type of press coverage on this subject, which is all too familar to us, will reply vigorously and not pussyfoot around with such people. It is too easy for journalists to write frightening stories about loonies, and so on, as they do and have done about institutions in my constituency.
If it is any comfort to hon. Members who might have doubts about matters such as these, I can tell them that I was involved in a lengthy case, the details of which I shall not repeat to the House—in particular, I assure the hon. Member for Plymouth, Drake (Miss Fookes) to that effect—which lasted for some years, involving an institution where people who had been undergoing treatment for mental disorder stayed on a hostel basis for varying periods of time.
A local dispute arose about this institution, but in spite of the fact that there was a bitter dispute—which is still going on—the attempt to use the fact that mentally disordered people living in that institution were living in an ordinary street did not succeed, because the residents of that street responded positively. They did not say, as the Sunday press would have them say, "We do not want these loonies living in our street". They said "These people are living in our street and we are concerned about them as residents of the street", and proceeded to form themselves into an action group, which fought—perhaps that is too strong a word—or agitated and tried to influence the system on behalf of the people living in that institution.
That, I think, is very encouraging. That took place, and is still taking place, in an urban area which had suffered, and still suffers, from the familiar manifestations of urban decay—an area where one would expect the worst kind of social prejudices to be foremost. That did not happen. I hope that no one in this House will object if I specifically name these people. They are the residents of Trafalgar Road, in Moseley, and they are to be complimented on resisting attempts to stir up old-fashioned, antique and quite savage prejudices about this subject.
That case raises another aspect of the Bill. What happens to people when they are no longer in hospital? If they are released more readily, what will society do about them thereafter?
My relatively recent experience of this—here I address the Minister, not for the first time, on this subject—is that society is not doing very much. We are slowly learning that people do not need to be incarcerated in secure areas of hospitals, or whatever, for indefinite periods of time simply because they suffer from some mental illness or mental handicap.
Recognising that, so far we are not doing very well at realising that these people need some special attention from society if they are not to be in a total environment such as a hospital or, indeed, a prison. They need a half-way environment—a half-free environment, if one likes—but certainly one where there are care and facilities offered by people who are not mentally disordered. We know that one of the consequences of being mentally disordered is that one is less competent and cannot do simple things such as cooking, washing and earning a living.
In my constituency we are unfortunate in having inadequate facilities for people who are no longer treated on an inpatient basis. That is an unfortunate omission. We do not have mandatory legislation that obliges local authorities to provide certain minimum facilities for people who have recently been in mental hospitals and who may or may not recover all normal faculties after a period of time within the community. Their chances of doing so would be enhanced if they left hospital and entered a reasonably safe environment within wider society. That, in turn, depends on those people being able to enter places such as hospitals, preferably run by people who have some knowledge and skill in terms of understanding the habits and requirements of the mentally disordered.
In our city we are not well off in this respect, and the involvement of the local authority is, to say the least, inadequate. As I believe was mentioned in the House recently, Birmingham is worse off than all the other large cities of our country. That is only one aspect of the situation. The provision of facilities for such people


varies in quality and adequacy throughout the country.
That brings me back to the purposes of the Bill. Quite rightly, the hon. Member for Chertsey and Walton (Mr. Pattie) seeks to ensure that people who are in hospitals as involuntary patients because they are mentally disordered should be able to seek their freedom. He maintained that their chances of being freed are doubled if this Bill gets on to the statute book, but I suggest that that is not enough if what happens to them after that means that they are at risk, and they will be at risk if they cannot enter an environment outside hospital which provides a certain minimal security in terms of their mental welfare, their physical well-being, their job prospects, and so forth.

Mr. Charles Irving: Does the hon. Member agree that it is a continuing national scandal that there are thousands of people in mental hospitals throughout the country who have no reason to be there other than that they have nowhere to go? Although successive Governments have tried to find a solution, it appears that some means must be found for encouraging local authorities to devote small units of council accommodation to patients who are likely to be assisted by voluntary bodies. MIND has done a superb job in this respect. This is a very much less expensive course than keeping hospital beds occupied by those who do not need them.
Does the hon. Member agree also with my hon. Friend the Member for Walsall, North (Mr. Hodgson) that it is pointless to put these inadequates and petty offenders into highly expensive psychiatric accommodation? I have in mind the man or woman who goes round tapping on windows. Recently in my constituency there was a man who was going round pinching ladies' knickers. He had done it 95 times, and was in great trouble. Whereas some ladies like having their bottoms pinched, no lady likes having her knickers pinched. But what is the sense of putting such a man into highly expensive psychiatric accommodation when hostels which are now growing in number could be expanded to provide not secure accommodation but adequate supervision to ensure that the public were not caused

distress by that sort of totally unacceptable behaviour? Would not that be better than what we are doing at the moment?

Mr. Litterick: I agree wholly with the hon. Gentleman. I think, too, that the effectiveness of clause 1 of the Bill is almost entirely dependent on whether society provides facilities outside hospitals.
If there is no significant change from present policies—I am talking about the policies followed by the State and those followed by the various local authorities—clause 1 will be virtually inoperable, for the reasons that the hon. Member for Cheltenham quite rightly highlighted.
I was speaking from experience in my own patch. I am aware that the hon. Member for Cheltenham is not inclined to push as hard as I am in this direction, but I hope that he will at least come some way along the road with me in suggesting that more of us should urge the Government to bring forward new legislation placing unavoidable obligations on local authorities to provide proper facilities for these people.
However it is done, it is now clear from our experiences in our constituencies that mandatory obligations or legislation is now necessary. How far we go with that legislation is a matter that we can argue among ourselves here at the appropriate time, but from the bitter experience of Moseley, clearly there is a crying need for legislation which will supplement this Bill, and I am sure that there will be a subsequent Bill providing us with the additional pages which the present one lacks.
If legislation such as this is to be successful, it is vital that society at large responds with resources and trained people. What is needed now is a willingness to impose obligations on local authorities rather than, as has happened in Birmingham, having the mentally disordered and mentally handicapped made into political footballs because a given local authority has a certain view of a particular type of expenditure. As the Minister knows, the types of local disputes which arise from that kind of issue are pretty sordid and squalid.
I wish to assure the hon. Member for Chertsey and Walton that I support his Bill wholeheartedly. I hope that we shall see him back next year with another


amending Bill and that, in the meantime, the Minister will come forward with appropriate supplementary legislation.

12.56 p.m.

Mrs. Lynda Chalker: Like every other hon. Member who has spoken, I welcome the Bill, and I want especially to congratulate my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) on bringing it forward, limited though it may seem to be to some hon. Members.
The work which is done by the all-party group for mental health—by my hon. Friend and by the hon. Member for Basildon (Mr. Moonman)—is one of the most successful collaborations in trying to review and bring up to date the law of the land in relation to one of the most neglected groups of people in our society. All hon. Members should be grateful for the work that MIND does in supporting our all-party mental health group and to all the various other voluntary bodies which bring to our notice continually the way in which the 1959 Act has now become out of date.
It is important to place firmly on the record that my hon. Friend's Bill is seen as the start of a comprehensive revision of the 1959 Act. It is hoped that in due time the Government will bring forward all those other measures which have come to our notice in recent years.
Before discussing my hon. Friend's Bill, perhaps I may be allowed to say a few words on the wider issue. My hon. Friend referred to the early-day motion as expressing the underlying wish of this House—by many more right hon. and hon. Members than those who signed it—that we should have a much wider debate on the subject of mental health before any further legislation is introduced. Not only have we had the White Paper, Cmnd 7320 published last September, but there has been a plethora of other reports, some of them Government reports and others from outside bodies, none of which has had a full discussion in this House.
Our last debate on this issue was two or three years ago when we discussed the Butler report, and even that was not a very extensive debate. Many people outside the House believe that a full-scale debate is necessary. My remarks in this connection, therefore, are really directed

to the Leader of the House. The bringing forward of this Bill by my hon. Friend the Member for Chertsey and Walton and the discussions that we shall have on it in no way absolve the House from a debate on the wider issue of the mental health White Paper and the Government's introducing in due course some legislation to revise the 1959 Act.
Simply because of the increasing numbers who suffer mental illness, we are constantly aware of our need to get to grips with this problem and to keep all these matters under control. It is evident from the speeches of a number of hon. Members that although the problem never seems to be one's own, it is constantly making different groups in our society aware that perhaps we are not dealing with some of the consequences of mental illness in the way that we should like.
It is well known that the 1959 Act introduced by my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) has been a good one but that the modifications required to it are now so extensive that, however welcome amending Acts are, we cannot go on making small amendments and must deal with the problem much more comprehensively.
As the number of mentally ill admitted to hospital has increased from 170,281 in 1966 to 190,358 in 1976 it is noticeable that the consequences have not always been fully recognised. The duration of stay in mental illness hospitals, and sometimes in hospitals for the mentally handicapped, is thankfully shorter than before, but we must be conscious of the problem that we present to the community and the problems faced by those who have had mental illness and who have relapses. These are problems that are not fully taken into account by aspects of other legislation, apart from the 1959 Act.
As the Bill is dealing with only a tiny fraction of the issues that are raised, we are asking for a further and more extensive debate. I hope that the debate will take place between a Monday and a Thursday so that more hon. Members can be educated on the problems of mental illness and the problems of those who have to deal with them, whether they be elected Members, officers or nurses. There is too much ignorance about the problems.
I sincerely welcome the Bill. I do not want my hon. Friend to get the impression that I do not consider it an excellent move on his part to bring it forward following his success in the ballot. However, it deals with only 10 per cent. of patients admitted on orders and only 5 per cent. of detained in-patients. That is a small chink of the total problem.
In Committee we must ascertain whether we can achieve more widespread agreement on two other issues that will further the success of the provisions already in the Bill. It appears from the comments that have been made, whether about staff or the problems of many informal patients—theoretically informal—that we shall be able to improve even this amendment Bill.
Two matters are referred to in the White Paper that are not to be found in the Bill. In paragraph 2.12 the White Paper recommends that section 25 of the 1959 Act should specificially provide for the short-term treatment of patients who go into hospital for 28 days but who are in hospital for observation under the section. Nothing is said about further assessment and treatment. The Bill is concerned with monitoring the progress of persons detained under sections 26 or 60, who often were first in hospital under section 25. We may be able to achieve agreement between the Royal College of Psychiatrists, the Government, the Opposition, MIND and all other interested groups on that recommendation and to improve still further the working of the 1959 Act as it would be amended.
The second issue with which we should be concerned is section 30 and the detention of informal patients already in hospital. Reference is made to that detention in paragraph 2.29. It indicates that it would be a good thing if we could amend section 30 so that an order that detains an informal patient may be signed by not only the responsible medical officer but, in his absence, by his nominated deputy.
In certain areas there is a great problem about the emergency detention of informal patients when the responsible medical officer may not be readily available. Paragraph 2.30 states:
Delays occur
when the responsible medical officer is not available that make nursing staff

unsure of their position in dealing with a patient who needs to be detained to prevent danger to himself or others.
We know that occasionally abuses have occurred because the RMO has not been available. Certain abuses have been set out in some public documents. One instance is mentioned in the White Paper. Apparently a stock of forms already signed was kept by the doctor for use when needed. With the new and growing attitude that we take to problems of mental health, we believe in constant monitoring. Practices such as keeping a stock of signed forms cannot be allowed to continue. It seems that a further minor change will receive all-party and all-interest support.
It is an occasion to be welcomed when the Royal College of Psychiatrists writes that it
welcomes Mr. Pattie's Bill unreservedly
and feels that his
amendments are useful modifications to the existing Act.
It is to be welcomed when MIND puts forward similar comments. I know that MIND has helped in large measure with the Bill's preparation.
Clause 1 deals with monitoring and renewal. Anyone who needs to be detained is obviously in dire stress and has possibly caused a good deal of disruption and stress in his or her family or to those who wish to help in future. The aim of the Bill to reduce the duration of authority for the initial period of detention to six months is an excellent move. The fact that the subsequent periods will be reduced from two years to one year is a further welcome amendment contained in clause 1.
There is one danger that I should bring to the notice of the House. If the authority to detain is to be renewed twice as often, there is a danger of renewal becoming rather mechanical. We must ensure that the review is thorough and is monitoring progress. The White Paper rejected the idea of requiring a second recommendation for renewal. Although we do not wish to make the process cumbersome, it is important that renewal is safeguarded so that the patient's case is properly reviewed. There may be various ways of doing that. That is a matter that the Committee will wish to consider in detail.
The mental health review tribunals will do more work than in the past. The


present work load of the tribunals is under 1,000 considerations a year. If the review body, wherever it sits, is to have a greater work load, we must consider the composition of some of the tribunals and provide up-to-date advice for those who sit upon them. We know that there is a medical man, a legal man and a citizen of some standing. In the complicated issues sometimes produced by mental illness, the tribunals need further advice. That may be even more important if the tribunal's work load is expanded as clause 1 implies.
In other parts of the Bill there is a further need for explanation for those servicing mental health review tribunals.
In clause 2 my hon. Friend seeks to insert the words "from serious harm", and there has been some question about what we define as "serious harm". My hon. Friend the Member for Walsall, North (Mr. Hodgson) and others have said that, where there may be psychological threat, "serious harm" might be considered more quickly to occur to an elderly, frail and lonely person than to someone young and robust. But most of us will readily recognise what a violent physical threat of harm might be.
I have come across a further problem in cases that have been brought to my notice, not only from my constituency but from the country as a whole. It is the question of the psychological harm that a seriously disturbed person may do to children in or around the place to which he returns. That is almost indefinable, and I am aware that here we are in the realms of judgment. But it behoves us to have another look at some of the cases of harm caused to children in this context.
We should also be mindful that this sensible amendment to the 1959 Act should not be allowed to give rise to the situations referred to by the hon. Member for Birmingham, Selly Oak (Mr. Litterick), which excite newspaper headline writers. One crucial way in which misunderstandings occur about mental illness and danger from patients is through the shorthand and sometimes ill-advised reporting of the minor occasions when a person who should be in care is not. If our society is better to understand the problems experienced at some stage in their lives by one in six women and one in nine men, we must make sure that the

safeguards are rigorous, well-researched and befitting the current situation.
That is not to say that we do not believe that the amendment to section 65 on public protection should not be made. Disturbed patients can cause serious harm. We have constantly been concerned about the way in which the legal profession has used section 65 to detain a person who, given the right care and attention in the community, should not be detained.
This raises the wider issue of community care for persons who have been mentally ill. The Bill cannot deal with that. But it underlines the need for us not just to encourage the co-operation of the community in dealing with persons who have been ill but to give more financial aid to local authorities to assist them in what this House throws upon them through legislation.
Turning to remission, I have not heard of any voluntary body or other group which believes that the recommendation of the White Paper in paragraphs 538–551, and indeed the Butler report, should not be developed into an Act of Parliament.
The final clause concerning voluntary patients deals with their mail. We are here doing something that has been called for by many bodies. We are relieving staff in our mental hospitals of an often unnecessary and dubious task. I am sure that the Committee will wish to develop this freedom for voluntary patients—if it is seen as that.
Finally, I turn to clause 5, which deals with money, and I have left this until now as it is a difficult matter. Clause 5 refers to the financial provisions for any increase arising directly from the amendments in the Bill. It is being said outside the House that the Government or an individual hon. Member seeking to reform the Act should not be unmindful of the consequences of so doing. The 1959 Mental Health Act is interlinked throughout. That may have a greater implication than that contained in the note on financial effects of the Bill. I shall be interested to hear the Department's thoughts on that, as it throws up a large number of other issues.
This is a good Bill. It may benefit from a couple of amendments in Committee, but we wish it a good speed and hope that, whatever the next few months bring, the Bill will be on the statute book


in the near future. I think that from time to time we forget how much we should be concerned with those who suffer from mental illness.

1.18 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle): I congratulate the hon. Member for Chertsey and Walton (Mr. Pattie) on his good fortune not only in being selected in the private Members' ballot but for having achieved a high place, enabling his Bill to come before the House relatively early in private Members' proceedings. It therefore has a good chance of becoming an Act and surmounting the various hurdles of which Back Benchers are aware. I also express my appreciation and that of my right hon. Friends for the way that the hon. Member has chosen to legislate on these matters.
Right hon. and hon. Members who have heard the hon. Gentleman speak have already divined that the Government support the Bill. This is the first step in the reform and further amendment and adaptation of the Mental Health Act 1959. It has been a great pleasure to have the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) with us today. I appreciate his kindly reference to my late father. I know the way in which he helped him in the primary task of putting the Mental Health Act 1959 on the statute book. I thought that the right hon. and learned Gentleman, was a little self-deprecatory in describing the effects that the passage of time has had on his Bill, in that he seemed to think that time had revealed gaps which must be filled. It is rather more a question of attitudes, ideas and techniques changing over two decades.
These days that is rather a long period between one change and another. There is a need, of course, to adjust our legislation to keep up with the times.
I prophesy that the Mental Health Act of 1979 or 1980, or whatever, will not be quite such a marked and radical departure from what went before as the right hon. and learned Gentleman's Act was from the situation that he discovered when he had the responsibility for altering our law on mental health back in 1959.
The Bill has been discussed without a great deal of reference to the background

against which it comes forward. It may be helpful to put matters in perspective. In 1976 the Secretary of State for Social Services initiated a review of the Mental Health Act 1959. One of the most pleasant duties that I had when I joined this Department was to take part in a debate and discussion on the way forward from the 1959 Act. That discussion was held at the United Services Club, in Pall Mall. It was a very profound, wide-ranging and interesting debate. All the leading personalities in mental health were there, and from that we proceeded to a general review and received a tremendous amount of evidence, which we then had to digest.
It took a considerable time for the Home Secretary and the Secretary of State for Social Services to consider the whole background and propound the White Paper that we have now put out for discussion. I am sure that hon. Members in all parts of the House will be happy to learn that the White Paper has some green edges. We expect that there will be further discussion and debate.
The four measures that have been put forward by the hon. Member for Chertsey and Walton are, in fact, measures on which there is little, if any, disagreement in the House and among the wider mental health interests outside. The four proposals in the Bill are proposals that the Government put forward in September in the White Paper on the review of the Mental Health Act, as part of an overall programme for reform of that Act. No doubt the hon. Gentleman keeps a close watch on these matters. He has selected four measures for which there is almost unanimous support.
The main effect of the Bill is to bring proposals into force until the much more major legislation to which the Government are committed is introduced. In that respect I can answer at least half of the representations made by the hon. Member for Wallasey (Mrs. Chalker), who asked for a debate on the mental health White Paper. Unfortunately, I am not in a position to say "Yes" or "No" to that. My responsibilities do not extend to arranging the programme of business in the House. I have no doubt that the Lord President will have his attention drawn to her suggestions and no doubt something will be done about it.
The hon. Lady also said that she hoped that this was not the end of legislation on mental health but that there would be a substantial amending Bill. I can promise her that there will be. The timing is a little uncertain, because we want to have full consultations with all the bodies concerned. There are some matters in the White Paper that are highly controversial—for example, the amount of force that can be used to restrain a difficult patient. I am sure the law relating to that will provoke substantial debate between Members representing the staffs of our mental hospitals and others who are equally interested in mental health but take it more from the patients' point of view.
The hon. Member for Chertsey and Walton introduced his measure with lucidity and a clear comprehension of the legal machinery that he was proposing for the solution of the problems involved. He has rightly earned the praise of all hon. Members who have spoken today. He has explained the purpose of his proposals very well indeed. I wish to give some indication of the benefits that the proposals will bring as well as to talk about the legal mechanics of bringing the changes into operation.
In this House there is a general realisation of the need to reduce periods of guardianship and detention for treatment. It is part of the wider movement from care in institutions to care in the community which is going on extensively in the area of mental health. That is in spite of the fact that some of the remarks passed during the debate have indicated that the movement is not fast enough to please all hon. Members.
I should stress that the periods laid down in the first substantial proposal are not really related to treatment as such, or to the periods of treatment as we see them. They are not meant to be treated routinely as a length of time for which a patient should be detained before consideration is given to his discharge. The responsible medical officer is expected constantly to keep in his mind the possibility that any patient within his care who is detained under compulsory powers need not be so detained. That is a continuing responsibility of the responsible medical officer. It would be generally agreed that as a further safe-

guard for patients, and to reassure them and their relatives that nobody is forgotten, provision is made under the law for regular revision and review of each case. This is achieved by providing that the detention shall end at a specified date unless it is renewed before then.
When somebody is made subject to the longer-term compulsory powers of the Act, he is being deprived of his liberty. Frequently, under our law, the question of mental health is inevitably involved with that of personal liberty. In the past, though I hope it will be less true in the future, patients in mental hospitals have lost their liberty for long periods of time. This is highly regrettable, and we all feel that the sooner we can reduce these instances the better it will be for the administration of our mental health service.

Mr. John Lee: Will my right hon. Friend deal with the concomitant problem of cases in which a detained mental patient is removed from a hospital of medium security to a high security hospital and where, in my submission, there is a need for independent adjudication? I know of such an instance, and if I am lucky enough to be called I propose to mention it.

Mr. Moyle: I would be interested to hear of the case that my hon. Friend intends to raise and though I did not intend to deal precisely with that specific problem at this stage I will listen to what my hon. Friend has to say and see what can be done to help. I know that the sphere to which he has drawn attention—the interface between ordinary mental hospitals and special hospitals—is one that inevitably arouses considerable interest on the part of patients and their relatives. What we seek to ensure under this proposal is that powers of detention are not used unnecessarily and for unwarrantedly long periods.
The proposal has two effects. It doubles the occasions when a doctor must formally review a case and satisfy himself that detention is still necessary. It means that there will be occasions when every case must come under review.
Inevitably, as each one of these review decisions is made, the indirect effect will be to increase the opportunities open to


patients to apply, or have their case referred, to a mental health review tribunal. Consequently, there will be more pressure on those tribunals. The hon. Member for Chertsey and Walton drew attention to that fact in commenting on the resource implications of the Bill, which I shall come to later.
The Government are sufficiently worried about the pressures on the mental health review tribunals by this alteration in the law to support transitional arrangements whereby the initial impact of this change might be substantially reduced in the initial stages. The Government are most grateful to the hon. Member for Chertsey and Walton for drawing their attention to that point by putting it into his Bill.
It means that some of the benefits of the new clause will be felt by some patients before others. We regret that very much; on the other hand, we are bringing forward these reforms well ahead of the main legislation. If the hon. Gentleman had not put this into his Bill, it is likely that the arrangement would have had to await the later legislation. That legislation might be in the next Session of Parliament or the one following. If it were in the next Session of Parliament, those arrangements would probably not come into operation until some time in the following session. Even though some patients and their relatives may feel that as a result of these transitional provisions they are being held back, the fact is that because of the energy of the hon. Gentleman the Member for Chertsey and Walton the question of liberty is being reviewed much earlier than it otherwise would have been.
Transitional arrangements are necessary in order to relieve the pressure on the tribunals that might result if there were a general flood of proposals coming forward as soon as the Bill reached the statute book, as I am confident it will.
I turn to section 65 of the Mental Health Act 1959, which is the subject of the second main clause. That clause brings the wording of section 65 a great deal closer to the intention of the 1957 Royal Commission. We found during the course of the debate that section 65 did not provide a very satisfactory control mechanism in the case of patients who were eligible for discharge but who

did not obtain it. The existing wording meant that people continued to be detained for not very serious offences.
We must make sure, by amending section 65, that restrictions will be imposed upon patients only when it is thought likely that they will be dangerous or cause considerable harm. Detention should not be imposed where the risks are minor, or relate to petty offences. The Act was not intended to deal with that sort of offence; it was designed to cover cases in which serious harm would result if restrictions were lifted.
When offenders are restricted there are implications for their management and security needs in hospital, in that hospitals, because of the increased restrictive management and security regime, sometimes find it difficult to offer suitable places to offenders under restriction. This must be realised, and this is where the third proposal will have its effect. The proposed amendment to section 65 goes some way to ensuring that such restrictions are not imposed unnecessarily.
The proposed amendment of section 74, via section 75, should mean that prisoners transferred to hospital would be subject to restrictions for a shorter period.
This might provide some indirect help in the placement in hospitals of mentally disordered offenders, and provide for some flexibility in the management of such cases. My judgment is that any benefit would be slight, but a slight benefit is better than no benefit. Problems of management in this context are difficult and complex, and any advantage gained will be welcomed.
Concerning the fourth proposal, it is remarkable that where we have informal patients we are still giving powers, to the doctors in mental hospitals, which amount to censorship of mail. I am sure that this offends the sensibilities of all Members who have taken part in the debate. No matter what alleviation we may introduce, there will be individual instances in which an acutely ill patient will send mail that will upset others or be harmful to his own best interests.
I agree with the hon. Member for Chertsey and Walton that the proper solution to the problem lies with discretionary powers, but even that cannot be truly effective. Great emphasis has been


placed by hon. Members on the shift from formal and restrictive to informal treatment, and in most cases that means exactly what it says. A determined informal patient would be free to leave hospital and post his own mail. The best solution, then, is to rely on sympathetic advice and persuasion by members of the staff to the patients concerned.
It is more consistent with the status of all informal patients that they should be free to correspond as they wish. The Government feel, as does the hon. Gentleman, that on balance the weight of advantage lies with repealing section 134, which imposes these draconian censorship provisions, and with removing a limitation on the rights of informal patients.
It is a regrettable comment on our debate that, with the exception of the hon. Member for Chertsey and Walton, there has been very little consideration by hon. Members of the resource implications of the Bill. This is something that no Government spokesman can refrain from commenting upon. In absolute terms, the sums involved are very small. The increase in the mental health review tribunal hearings unfortunately cannot be reliably estimated. We cannot predict the extent to which patients will choose to take advantage of their new opportunities, although I am sure that many of them will. Our highest estimate assumes an increase in hearings of about 50 per cent. The practical results are likely to be somewhat less than that, but I would not wish to forecast by how much.
It is expected that the existing review tribunal staffs will be able to cope with the extra work load without any need for increased recruitment, but there will be additional fees and expenses for members and expenses for witnesses likely to total between £25,000 and £50,000 in a full year.
I realise that there is a 100 per cent. variation between those figures, but that will indicate that I am talking in fairly broad terms. Nevertheless, even a variation of that size can be contained within the Estimates for the 1979–80 financial year. The Bill would come into force only in the second half of the year, and the transitional provisions would mean that the increase would build up slowly. The public expenditure survey alloca-

tions for 1980–81 and beyond already provide plenty of elbow room for implementation of the proposal.
Many patients seek help from solicitors in preparing for a tribunal, making demands upon the legal assistance and advice scheme. No reliable estimates can be made, but it is thought that this will cost, at most, £25,000 in a full year. The Lord Chancellor's Department feels that it can absorb this increase within the allocated planned expenditure.
Resources are not only a question of money; there are manpower implications. I understand that the Home Office is likely to be burdened with an increase in staff of one, who will help with the increased processing of cases referred by the Home Secretary to the tribunals. The Home Secretary, however, feels that this problem can be solved within his Department.
I am happy, therefore, to assure the House, on the basis of somewhat more detailed calculations than the hon. Member for Chertsey and Walton was able to make, that the resource implications that he foresaw for his Bill are substantially confirmed. This legislation will not only be effective and desirable; it will be economical to operate.

Mrs. Chalker: I asked the Minister of State about the wider expenditure implications of the Bill. I realise that he might be unable to deal with that aspect now. These worthwhile and economical amendments may open up a new avenue of expenditure, and before the Committee stage, therefore, it would be helpful if the Department could examine these wider expenditure "threats". We would hate the Bill to fail through our failure to take account of those implications.

Mr. Moyle: I think that the implications, so far as we can foresee them, have all been taken into account. We do not foresee any further problems. If the hon. Lady has any in mind, I shall certainly consider them if she lets me have a note of them. I shall see what we can do to meet those problems.
My hon. Friend the Member for Lewisham, West (Mr. Price) was most anxious that staff interests should be considered. He was anxious that there should be no tendency on the part of my Department to fail to consult COHSE and


NUPE during the course of future legislation. Fortunately, the hon. Member for Chertsey and Walton is fully seized of his responsibilities with this Bill. I can reassure my hon. Friend that the Department now makes a practice of consulting fully the staff nurse unions involved in mental hospitals, particularly COHSE and NUPE, on all policy matters. There is, of course, local machinery for joint consultation on local problems.
My hon. Friend the Member for Basildon (Mr. Moonman) was anxious to ensure that general practitioners should be encouraged to monitor cases of mental ill health in the community before such cases are received for treatment at mental hospitals. That is most important.
We are debating the Bill against the background of a general desire to move the treatment of mental patients away from institutions and towards care in the community. Three of the proposals in the Bill have some bearing on this issue.
The hon. Member for Walsall, North (Mr. Hodgson) spoke of the importance of educating the public in this direction. I agree that that must be done. In spite of 10 years or more during which care has been shifted towards the community, people are still apprehensive at having more mentally ill or mentally handicapped people among them.
That attitude arises from a lack of awareness of the new medical and psychiatric therapies and techniques that have been developed over the past 20 years. As responsible parliamentarians, we should proceed with educating our constituents in these matters. Debates such as this one help in that process, as does much of our other work.
My hon. Friend the Member for Birmingham, Selly Oak (Mr. Litterick) has previously mentioned the problems of looking after people in the community. He said that the care of the mentally ill and handicapped was worse in Birmingham than in any other big city in the country. At Question Time last Tuesday, I commented unfavourably on the standard of mental handicap and mental illness care in Birmingham, but I think now that my hon. Friend rather over-emphasised the matter. Birmingham is worse than many of our big cities in this respect, but not worse than all. Somewhere there is, possibly, a big city with a worse record.

Mrs. Chalker: The Minister knows that we are aware of this, but we must pay greater attention to the fact that many of these big cities attract those who need the most help from the community psychiatric services. The development of the community psychiatric service must necessarily precede, both in training and in finance, what we can refer to as a much better standard of treatment, which every hon. Member wants but which regrettably, in the present resource situation, will not be an overnight change, whoever may be controlling the purse strings.

Mr. Moyle: I agree with the broad principles behind that intervention. Nevertheless, there is a responsibility on all local authorities, which now control their social service departments and which are primarily responsible for care in the community, to do the maximum within the resources allowed to make due provision. I thought that my hon. Friend the Member for Lewisham, West was a little hard on the Government when he talked about the resources which will be made available for care in the community. He seemed unaware of the substantial effort that the NHS is making through the technique of joint financing to deploy NHS money towards the social service departments of local authorities. We shall deploy about £35 million in this way this year and by 1981–82 the total will have reached £40 million, uprated for inflation.
Most of our guidance to local authorities is directed to helping them to provide resources and care in the community for the mentally ill and handicapped. We are well aware that the elderly always have tremendous electoral sympathy in the competition for social service resources, which the mentally ill and mentally handicapped do not have. Therefore, the efforts of my Department are directed to getting the maximum proportion of that joint financing money directed towards those two latter groups.

Mr. Hodgson: May I ask a slightly unfair question? I fully appreciate the need for local authorities and social service departments to be responsible and to look after their local populace, but has the Minister's Department considered the proposals of the next Bill that the House will consider today—the Chronically Sick and Disabled Persons (Amendment) Bill? That will have a great undermining effect


on the independence which both the Minister and I wish local authorities to have in the way in which social service departments do their spending.

Mr. Moyle: There is always tension in these matters. We are all anxious to establish local democracy and to ensure that people take their own decisions locally, and that there is rough uniformity between standards of care for our less fortunate citizens. From time to time, Governments have to insist that certain standards are maintained, or, if they cannot go that far, at least to give a lead to the institution of certain standards. Joint financing is a typical example of this latter approach.
I hope that the Bill has a brief, brisk and effective Committee stage, so that we can welcome it back and send it to the Lords as quickly as possible. The possibility of future accidents has been mentioned. I am sure that we can manage to get the Bill on the statute book before anything like that happens.

1.55 p.m.

Mr. John Lee: The hon. Member for Chertsey and Walton (Mr. Pattie) will, I think, acquit me of any discourtesy in not having been present when he moved the Second Reading, because I was professionally engaged elsewhere. I was pleased to see the Bill on the Order Paper, and I was fortunate enough to hear the speech of the hon. Member for Wallasey (Mrs. Chalker), who applied to this matter the sensitivity and good sense that she always shows.
My purpose is certainly not to retard the progress of the Bill. I should like, first, to use this opportunity, which I think would be in order, to quote examples of lacunae in the law. I intervened in the Minister's speech in anticipation of something that I wanted to raise later, but I should like first to mention another disturbing case which I encountered some time ago in a professional capacity. It would be wrong, and I she not attempt, to identify it—not least because the matters are still the subject of further legal determination and also because it would be professionally improper so to do.
Some months ago, the case arose of a very sick woman with a record of violence and a long history of in-patient treatment punctuating her sad life, about whom there was every reason for apprehension. Yet the local authority to whose attention the matter was drawn—there was no relative to raise the matter—declined to take action.
Not long afterwards, the woman committed against a child an act of violence which, happily, was trivial in its outcome but which so easily could have resulted in death, and certainly in serious injury. The woman was arrested, indicted and brought for trial. When the matter came before the Crown court and the medical history, supported by comprehensive medical and social inquiry reports, was put before the judge, it was apparent that the incontrovertibly correct solution was that she should be made the subject of a Mental Health Act order and not of a direct punishment.
Inquiries were made about a place for her but the learned judge found that there was no mental hospital willing to take her and that he had no powers under the Act to compel the hospital to receive her. It was not considered—I think rightly from my recollection of the details—of such acute seriousness, despite the history of violence, as to warrant an order which would have committed the woman to one of the three high-grade mental hospitals, Broadmoor, Rampton or Moss Side.
The judge was left with three choices. One was to let the woman go, with every prospect of a repetition of violence. I say "let go" in the sense of imposing a non-custodial sentence. A second was to make a Mental Health Act order, which he knew would be disregarded because of the absence of power in the law to enable him to compel a particular named hospital to accept her. The third was to pass a sentence of imprisonment.
In the end, the only course the judge was able to take was to pass a long sentence of imprisonment. He was obviously distressed and upset at having to do so and commented, at the time of passing sentence, that it was obviously an inappropriate decision. He did so in a spirit of humanity because he did not wish the sentence to be regarded as an indication of the court's proper view of the situation.
The judge also hoped that in due course the matter would be the subject of investigation, so to speak, behind the scenes and that it would be fully ventilated in the Court of Appeal. I understand that the latter, at any rate, will ultimately happen.
This is not the only instance I have encountered. The hon. Member for Chertsey and Walton knows of this situation. It may be argued that that a judge can make a directive, ordering that someone should be detained. But a hospital may conscientiously feel that it cannot cope. While not wishing to be awkward or over-cautious, it may take the view that there is serious danger to other patients, danger of disruption in the hospital, danger of escape, or some other bona fide reason.
One cannot allow a situation in which the purpose of the Mental Health Act, or an important segment of it, can be defeated by the absence of the powers vested in the Crown courts to be able to make a proper disposal order. I have mentioned that case in anonymous terms. I know that the judge, a sensible and humane person, was troubled about it and would wish that I should do so. When this Act, now 20 years old, is comprehensively reviewed, not only in the context of the hon. Gentleman's useful Bill but in the wider context of a general review, I hope that this lacuna in the law will be put right.
I know of another instance, perhaps not in such acute terms. Difficulties arise in that grey area between punishment and mental treatment of an offender. A case occurred two or three years ago of a man brought before a court on a comparatively trivial assault charge. It was readily apparent to everybody—warders, solicitors, counsel, and, in due course, the court—that he was mentally disoriented. Everyone was aware of that, except the prison medical officer at Brixton, whose attitude might be cynically summed up as that of Army medical officers confronted with walking wounded or walking patients and working on the assumption, which takes a lot of rebutting, that they were malingerers.
The medical officer certified that the man was fit to plead. As it was patently impossible for any kind of coherent or rational instructions to be obtained from the individual concerned, there was resort

to the comparatively rare procedure of a trial on fitness to plead. In spite of the absence of medical evidence supporting that contention, the special jury empanelled for the purpose of trying the preliminary issue sensibly concluded that he was unfit to plead and the man was accordingly detained.
In that instance, if my memory serves me right, he was detained in a high security mental hospital. He was detained for a period of 18 months or more. Happily, in the course of that time, he recovered. In fact, he recovered to such an extent that he was certified as being fit to plead, it being implicitly conceded that the original medical certification that he was unfit to plead was wrong and that he had been ill but had recovered. The case was then reopened. By coincidence, it came before the same judge and with the same counsel on either side. This is a rare instance. Usually briefs are returned, shunted around and taken by other people. It is very rare that the same judge and counsel find themselves dealing with the same case some 18 months after the original matter has seemingly been disposed of.
The question then arose that if he was fit to plead, what should be done? Because he was not fit to plead, the court could consider the question of plea and, in the event of conviction, of punishment. Had the man been perfectly sane in the first place, the court would at the very most have imposed a much shorter period of prison and detention than the man spent, as it were, behind bars but in a mental institution. In all probability the case would have been resolved by way of a fine or suspended sentence. Fortunately, the judge concerned dealt with the matter sensibly and humanely. He imposed a nominal sentence after the man had entered a plea of guilty.
That case seems to me to illustrate in a dramatic way the difficulties that can arise over people who are thought to be sane but in fact are not. It certainly made me cynical about the competence of the prison doctor who adjudicated on the matter.
That will lead me later to something more directly referable to the Bill. It also raises a matter to which the Bill refers and to which my hon. Friend the Member for Birmingham, Selly Oak (Mr. Litterick) alluded—the problem of aftercare of people who are discharged. This


was one of the difficulties facing the judge in the case to which I referred. This often happens when a person has been detained in a high-grade mental hospital. When he leaves and is free lawfully to go about his business, where does he go? Will hostels take him? It is difficult to find bail hostels for persons of no fixed abode where there are no mental problems but only problems or difficulty in the acceptance of an offender. Where there is an antecedent history of violence and mental disorder, the problems of slotting such a person into the community, of not leaving him literally homeless and on the street, is enormous. The hon. Member for Cheltenham (Mr. Irving) rightly and commendably champions people in this unfortunate situation. He will understand what I mean.
I raise these matters because it is right that they should be mentioned. The House will be interested to know of them and will wish to bear these problems in mind when there is a general review of the mental health legislation.
The hon. Member for Chertsey and Walton rightly seeks to increase the degree of external invigilation of persons, and the circumstances of a person's detention, by reducing the time and by making it the subject of tribunal review to a greater extent than happens now. He is entirely right. I do not think that we shall get very far unless and until the legal aid scheme is enlarged to cover tribunal work in a way that it does not do now. Often the persons concerned and their families are of limited circumstances. They can pay only modest fees, and such representation is not easy.
This is not my area of law. However, I represented a person before a Mental Health Act tribunal, in relation to which I put a question to the Minister about someone who has been arbitrarily moved from an open mental hospital to a high-grade security hospital without reference to anyone. That was one of the matters that came up. It was not the determining factor. In the event, the person involved was discharged. It was thought that the detention ab initio had been wrong and should never have happened. The situation was exacerbated because he had been detained improperly and im-

properly removed from a low-grade to a high-grade hospital.
Until there is an enlargement of the legal aid scheme, so rightly and generously available for people accused of criminal offences, to cover tribunal work, including Mental Health Act tribunal work, the provisions in the Bill will not be adequate. Therefore, the estimate of the cost of this procedure may turn out to be much larger. I hope that it will. Unlike many hon. Gentlemen, I believe in high Government expenditure on many matters, and some members of the Opposition believe in high expenditure on this matter. The civilised members of the Conservative Party are here today. The Monday Club yahoos have gone home after yesterday's debate on Rhodesia.
It may not necessarily only be a question of providing legal aid to enable a patient properly to instruct a solicitor and counsel for tribunal representation. There will be instances where, by virtue of comparative feebleness of mind, incoherence and inarticulateness, it will be desirable if a person cannot give poper instructions that representations should be made amicus curiae.
I shall use the analogy of the Official Solicitor in relation to other matters. Someone may be appointed by the tribunal to represent a person who is not able articulately to give instructions, and who is not fully aware of his rights and does not have a family pressing on his or her behalf for representation and redress of grievance.
The debate may or may not continue. We have heard the principal speakers already. I am glad that the hon. Member for Wallasey is present. I am sure that she will be interested in at least some of what I have said. I do not claim that there is any merit in my speech save in so far as I have been able to draw attention to one or two aspects of this complicated and important matter which a humane and civilised society certainly would wish to consider.

Question put and agreed to.

Bill accordingly read a Second time.

Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).

Orders of the Day — CHRONICALLY SICK AND DISABLED PERSONS (AMENDMENT) BILL

Order for Second Reading read.

2.16 p.m.

Mr. Edwin Wainwright: I beg to move, That the Bill be now read a Second time.
I appreciate the opportunity to introduce this Bill, which I am certain will strengthen four provisions of the Chronically Sick and Disabled Persons Act 1970.
I hope and expect that it will be non-controversial, as we want to make cerain that we can quickly deal with the points in this Bill so as to strengthen the Act. I should like to thank the Opposition, especially the hon. Member for Chertsey and Walton (Mr. Pattie), for giving time for the introduction of this Bill. Hon. Members on both sides regulated their speeches. For that I am grateful. I am pleased that the hon. Member for Wallasey (Mrs. Chalker), who is an Opposition Front Bench spokesman stayed with us for some time, although I am aware that she has an important engagement not too far ahead.
I believe that the 1970 Act, which was piloted through Parliament by my right hon. Friend the Under-Secretary of State for Health and Social Security with responsibility for the disabled, was a milestone in our social legislation. Indeed, in human terms it is as important as any Act on the statute book.
Often we leave on one side those who have been born with or have suffered from disablements which have greatly restricted their lives. Therefore, that wide-ranging Act gives direct help to 1 million severely disabled people. Indirectly it helps millions more by its general provisions, especially those relating to the improved access to public buildings. It aiso helps families, because once the ability of one member of a family becomes impaired the result among the whole family is a feeling that they are a handicapped family.
I come from a mining community. I know only too well what a breakthrough was accomplished by the Chronically Sick and Disabled Persons Act for disabled people and their families. Many times in

my early days I saw young miners who received severe back injuries and were confined to a chair. Many times such a man got outside the door of the house only when someone carried him there. Therefore, the Act has been of great benefit to people in the mining community and others who have been severely injured.
I have watched with great pleasure the gradual extension of the Act and the strengthening of its provisions. In 1972 the Conservative Government extended it to Scotland; in 1978 it was further extended, in its entirety, to Northern Ireland, thus becoming a United Kingdom Act. Following the passage of an amending Act in 1977, its provisions for improved access were applied to places of employment, so helping to remove discrimination against disabled people at work as well as those with leisure opportunities.
Of course, not only was my right hon. Friend the creator of the 1970 Act; in his present post he is committed to furthering the interests of disabled people on all fronts, and he is constantly seizing upon new opportunites for improving the quality of life of disabled people and ensuring that they have the rights to which they are entitled. His dedication has been recognised recently by his appointment to Her Majesty's Privy Council, and I am sure that all Members of the House join me in congratulating him on that well-deserved honour.
I know that despite the tremendous progress made in the nine years since he introduced the Act my right hon. Friend is the last person to believe that we can afford to be complacent. I am keenly aware, from my daily contact with my constituents as well as from discussions with interest groups representing disabled people, of how much more there is still to be done before the full social purposes of the Act and its meaning can be realised.
That is why, when I was fortunate enough to win seventh place in the ballot for Private Members' Bills, there was little doubt in my mind about what I wanted to do, and about the Act that I wanted to help, sustain and strengthen. I have tackled the task through four amendments and I will describe them briefly to the House. Before doing so I want to say a word of thanks to all those organisations


and individuals who sent to me certain suggestions about what I should put into the Bill.
I could have obtained a good deal of publicity if I had accepted some of them. Nevertheless, I thought, and think, that what I propose to do in the Bill is the best, and, therefore, although I am grateful to all those organisations and individuals for making their suggestions to me—I hope that they do not feel that I did not consider their suggestions, for I can assure them that I did so most carefully—I made up my mind that the unfortunate disabled people ought to have my blessing through some amendments to the existing Act.
The first and most important change in the Bill relates to section 2 of the 1970 Act. That section lays on local authorities the duty of providing a wide range of services to disabled people, whether or not they are registered, but once they are registered the local authority must be satisfied that there is a need to provide such services. The services include such essential items as adaptation of homes and, along with additional help in providing telephones, all kinds of aid and equipment. This is a wry wide area, and it has come to the fore in the last few years.
Tremendous benefit has been derived by disabled people from the social services in this effort to enable them to live a fuller and better life. These services, together or separately, can transform the lives of disabled people by enabling them to stay in the community, to be in their own homes, where they belong, and to do so with the maximum degree of comfort and dignity, thereby stimulating the desire to live a fuller life.
It was until last year always believed that it was open to a disabled person, if he or she was aggrieved by the failure of the local authority to provide one of the services set out in section 2, to seek a remedy in the courts. Unfortunately, the judgment of the Appeal Court in the case of Wyatt v. the London borough of Islington in May 1978 showed that that was not after all the case, and that the only remedy open to a disabled person in that position would be to apply to the Secretary of State to use his default powers under the National Assistance Act 1948.
Understandably, disabled people feel that that is not satisfactory either in principle or in practice. The purpose of clause 1, therefore, is to remedy the situation by restoring the position to what it was believed to be before the Hillingdon judgment. The clause is designed to amend section 2 so as to insert after subsection (1) a provision to the effect that when a disabled person has requested a local authority to make any of the arrangements specified by section (2), and the authority has accepted that such arrangements need to be made in order to meet the needs of that person, if the arrangements have not been completed within a reasonable time the person who made the request may make an application to the county court for an order directing the authority to make the necessary arrangements.
In proposing that amendment of section 2, I recognise that it does not go as far as some proposals which have been canvassed. The opportunity of recourse to the courts is limited to those people whose local authority has recognised their need for a service or services but has not met that need. I am aware of the suggestion that there should be imposed upon local authorities a wider and stricter statutory duty. I am also aware that support for such suggestions springs to a large extent from a justifiable dissatisfaction with variations in the provision of services between one local authority area and another.
Nevertheless, after much hard and careful consideration, I concluded that a measure more modest in scope, as proposed in clause 1, offers the right and only practicable solution. It restores to disabled people the right that they believed to be theirs. At the same time, it does not conflict with the proper exercise by local authorities of their functions, bearing in mind that those authorities are answerable to their electors and cannot be allowed to opt out of their duties, and if they perform those duties badly they can expect the political consequences of failing the needs of the local disabled people. As far as legal representation is concerned, local representatives are in a better position than central Government to make those assessments. They are closer to the people and therefore should be aware of the people's needs and act accordingly.
Whitehall solutions are inevitably remote and reached with less knowledge of the circumstances of individuals. However, I am not happy with the performance of some local authorities in helping disabled people under the Act. Disabled people and those who care about disabled people can do much to make laggard authorities face their responsibilities without the need for the introduction of more extreme statutory measures.
For example, local organisations for disabled people can pinpoint and publicise cases of urgent need and ensure that the local authority deals with them. Some local authorities are spending considerably less on helping disabled people than others in comparable areas. Local councillors should be asked to explain why, and their attention should be drawn to their statutory duties. I do not believe that that is done often enough, in spite of the great interest that has been aroused in the last few years in the fact that there is still insufficient care for disabled people.
The councillors should be reminded that it is a failure of their duty to reduce the services without proof of diminished need. Local authorities should be urged to carry out their duty under section 1 of the Act, not only to provide services but to ensure that disabled people are informed of their rights and helped to make full use of those services.
I believe that there should be a change in attitude which cannot be achieved by legislation alone. The constant vigilance and concern shown in the practical ways that I have mentioned can assist the disabled However, I urge hon. Members on both sides of the House to bear in mind in their constituencies the need to arouse interest in the care of the disabled.
One provision of the Bill is designed to amend section 4(1) of the 1970 Act to ensure that the Secretary of State lays before Parliament a report on proposals for further improvement of access to and within public premises for disabled people. Much has been achieved towards the aim of ensuring that disabled people go where the able-bodied can go, so that they may take their proper place in the community and enjoy leisure activities on equal terms.
Not only has the Act led to improvements in access; the Silver Jubilee access committee that was set up by my right hon. Friend the Under-Secretary of State

for Health and Social Security has led to improvements in access. The committee reported last week, after a year's intense activity and informed inquiry regarding all aspects of improving access for disabled people. I have read the excellent report and I hope to see its recommendations accepted by the Government, who have already given a pledge of good faith by setting up a successor body—the committee on restrictions against disabled people.
I paid attention in the Bill to one of the Silver Jubilee committee's recommendations to which I was sympathetic. The recommendation was that the sections of the 1970 Act that deal with access to new buildings—sections 4 to 8—should be made mandatory. In that way, the onus of proof would be transferred to developers, who would have to demonstrate irrevocably that it would be unreasonable or impracticable to incorporate access facilities for disabled people in new buildings.
I have sympathy with the thought behind the recommendation, but I feel that it is for the Government, to whom the report was made and who are giving it careful and sympathetic consideration, to respond to the recommendation by amending the appropriate sections of the Act. I repeat that I hope that the Government will be able to do so. Meanwhile, the aim of the clause in relation to access is that it will help provide a focus of attention on the vital importance of further improving access for disabled people.
Paragraph 11.10 of the report under the chairmanship of Peter Large says:
We consider that Government, both central and local, and its agencies should set an example to everyone else. The Property Services Agency announced recently that, in the financial year beginning April 1979, it will provide £½ million to adapt at least one public building in each of 56 towns.
We are pleased to hear that news. The report continues:
Even so there are still too many DHSS local offices, job centres, hospitals and doctors' and dentists' surgeries where access is so poor that disabled people cannot reach them.
Paragraph 11.11 says:
However, we do not think that all the private sector will necessarily follow the example set up by public organisations. We believe that the only way to ensure access to new buildings would be to make it illegal not to include the necessary design features.


Earlier (paragraph 1.5) we noted that the Department of the Environment intends to consider the practicability of amending building regulations to incorporate the revised Code of Practice. We hope that they do so quickly. We recommend that legislation be introduced to make the access sections of the Chronically Sick and Disabled Persons Act 1970 mandatory. Further, we recommend that the law be amended to place on developers the burden of proof that to make a new building accessible would be unreasonable and impracticable.
I recommend every hon. Member to read that helpful and interesting report, which is vital for the future of the care of the disabled.
The remaining two provisions of the Bill are designed to extend and strengthen the 1970 Act. Section 17 of the Act provides that health authorities should use their best endeavours to secure that, as far as practicable, young chronically sick and disabled people who have to spend time in or even live permanently in hospital are not cared for in part of a hospital normally used wholly or mainly for elderly people. I believe that that is to be commended, and it has already done much for younger sick and disabled people.
The Bill seeks to apply a similar provision to residential homes provided by local authorities under part III of the National Assistance Act. It is designed to ensure that local authorities shall use their best endeavours to secure that, so far as is practicable, no person is cared for in residential accommodation that is normally used wholly or mainly for the care of elderly people unless he is himself elderly. I believe that is important, because if disabled people are to be regarded as entitled to the same rights as the able-bodied—as I believe they must be—among those rights must be the companionship of people of their own age and the opportunity to participate in activities designed to appeal to them rather than to older people. Old people often require different facilities and different types of social stimulation.
I also feel that it is necessary to extend the Act to cover local authority homes because of the increasing tendency for physically disabled people to stay in the community rather than to go into hospital.
Section 18(1) of the parent Act requires the Secretary of State to take steps to obtain from local authorities information on the number of people under the age of

65 who are resident in local authority homes which provide accommodation for people over that age. My proposal extends that provision to homes registered under section 37 of the National Assistance Act—that is, private homes approved by the local authority. The thinking behind this is that young people, simply because they are handicapped, should not be confined to the company of people many years older than themselves. By informing himself of the extent to which this may be happening in privately-run homes as well as local authority homes, the Secretary of State can act from an informed base in considering how it should be discouraged.
The amendments that I have put forward today are modest. Nevertheless, I believe that they will help to improve the position of disabled people in society, and the introduction of clause 1, in particular, will give them hope that their rights will be strengthened.
I also believe that all hon. Members will agree that disabled people, whatever their physical disadvantages, must have no less right to the fullest and most fulfilled lives that our society can offer than those of us who are abled-bodied. It is in that confident belief that I urge the whole House to support the Bill.
I should like to thank hon. Members on both sides of the House who have shown interest in the Bill. In particular, I thank my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), whose name is known throughout this country, because he has done a tremendous amount of work for all disabled. I am pleased that he is here today and I hope that he will catch your eye, Mr. Deputy Speaker, to say a few words in support of the Bill.

I commend the Bill to the House.

2.42 p.m.

Mrs. Lynda Chalker: I rise to speak now, and I hope that the House will forgive me for having to depart for the North shortly and therefore not remaining for the rest of the debate. I do not think we expected the Second Reading of the Bill to be taken today.
Anyone who has dealt with and been interested in the problem of the physically and mentally handicapped over many years will well understand the points made by the hon. Member for Dearne Valley


(Mr. Wainwright). We understand the intention of the Bill. I think that no one is more keen than him and his hon. Friends and me and my hon. Friends to facilitate in every possible way disabled people's access not only to places of necessity in shopping and attending to their needs in life but to places of entertainment and other walks of life to which for so long they have been denied in many of our cities. We are entirely sympathetic with the hon. Gentleman's wish to improve access in all its many aspects.
I know that the hon. Gentleman is totally and utterly sincere in his proposal concerning the separation of younger people from older persons in certain types of accommodation. It may be that in Committee that part of the Bill will need to be amended, because, with the best will in the world, local authorities will be unable to provide sufficient care for a disabled person unless that person, whatever his or her age, is in the only facility which exists. I think that we must look at that matter with great care.
I am sure that we have all been delighted to read the report by Peter Large and his committee—the Silver Jubilee committee—on improving access for the disabled. I should like to put one question to the Minister on this matter. He has now set up a successor committee to the Silver Jubilee committee on access. It would be helpful if, either to the all-party group, or, even better, to the House, he could in due time make more detail available about the working of this successor committee. I make that request because many people do not realise the extent of the problems of access, just as they do not realise the problems of mental illness and all that that brings forward. Therefore, it would help the cause of the disabled as a whole if we had these points on access brought to the notice of the House.
I turn now to my real worries about this little Bill. The hon. Member for Dearne Valley described the Bill as modest. However, the more he described what it would do, the more I felt that it was not nearly as modest as he perhaps at first intended. If I understand his intentions aright, we shall need to redraft the clauses because I believe that the extent of the Bill will go a good deal wider than we have heard today.
I should make it clear for the record that the Opposition fervently wish for an improvement in the economy. One of the things for which any improvement in the economy must be used is the improvement of facilities for both the physically and the mentally handicapped. Until that improvement is with us, we must not raise the expectations of people so that they feel denied when a local authority says that the money supply is not available to carry out this or that improvement.
I submit that the Bill will cost a great deal of money. There is no financial resolution and no comment in the Bill on expenditure. Therefore, I ask the Minister—because he may not be able to tell us anything on this aspect this afternoon—to go away and, with his Department and local authority associations, examine just what expenditure will be involved if this measure becomes law. It is not that we do not wish to see it become law. It is that we do not wish to raise the expectations of disabled people by putting a measure on the statute book the provisions of which we find ourselves unable to fulfil.
Unless the Government are to make funds available for the full implementation of this measure—I cannot believe that to be the case; otherwise it would have been written into the Bill—we must proceed with a little more caution than might have been thought necessary from the terms of the excellent speech by the hon. Member for Dearne Valley.

Mr. Edwin Wainwright: We must not forget that the provisions of the Bill are not a great step forward. I do not think there will be such a need for money as the hon. Lady mentioned. The hopes of the disabled have been rising tremendously for many years. I sometimes think that they have not risen high enough. Let us not forget that we are trying to help the disabled to live better and fuller lives in society.

Mrs. Chalker: I well understand the hon. Gentleman' intervention. But, frankly, I do not believe that any Member of Parliament, Front or Back Bencher, should seek to promise what he cannot deliver. That merely brings Parliament into disrepute, and that concerns me greatly.
I think it is generally felt that a totally new move is being made in clause 1(2). That seeks to put in question, without any redress for local authorities, the powers and duties of local government. I am sure that many hon. Members will have received, as I have, a letter about this aspect of the Bill. I am informed that it is totally unprecedented that such general powers and duties in relation to a particular client of the community should be made enforceable through the courts.
A recent court case has given rise to this matter. Therefore, it will be of assistance to the House and everyone concerned if a full explanation could be given by the Minister in reply to the debate. We do not, in any way, wish to resist the improvement of facilities for disabled persons, but the way in which that has been brought forward requires detailed investigation by the parliamentary draftsmen and the Department. I hope that the Minister will give us an assurance that he will look at the Bill in this way so that we may be totally aware of the promise that the Bill really contains.

Mr. Lewis Carter-Jones: I am rather surprised that the hon. Member for Wallasey (Mrs. Chalker) takes this point, because the Bill says
if the local authority has identified a need".
That means that it has done its duty of identifying the need, and the Bill says that it must be implemented, that is all.

Mrs. Chalker: I am grateful to the hon. Member, because he has pointed to another problem. I think it might be argued in law that many local authorities have done all that they can to identify the need. But the vagaries of the rate support grant—even though such matters are taken into account—are such that in some years it is impossible for local authorities, without further central Government subvention, to fulfil all the needs which they have identified in a better economic situation.
I can think of many instances where a local authority is aware of the need to help a particular group but the following year the rate support grant has been less than anticipated and it has therefore been unable to fulfil that need. If we are asking local authorities to be much more careful about the way in which they identify

need, that is a different matter. What we need to do is to make sure that we do not promise something that we cannot carry out because central Government do not make the funds available to local government.
We shall examine the Bill with great care. I hope that the House will forgive my short intervention and the fact that I now have to depart.

Mr. Edwin Wainwright: If there is any part of the Bill about which the Opposition feel strongly, I think they will find that we shall look into it carefully and considerately to make sure that the good parts of the Bill come into the Act.

Mrs. Chalker: I am grateful to the hon. Gentleman for giving that assurance. That is the best way of doing it and the way in which we always proceed on matters concerning the disabled. I sincerely hope that the good parts of the Bill will succeed.

2.52 p.m.

Mr. Jack Ashley: I appreciate the kind words spoken about me by the sponsor of the Bill. I hope he will not take it amiss if I criticise his Bill, because I believe that it is grossly inadequate for dealing with the problems raised by the Wyatt case.
The Bill is based on one that I put forward some time ago, but it has emerged in an emasculated form. I do not criticise my hon. Friend the Member for Dearne Valley (Mr. Wainwright) for that. I support the Bill and congratulate my hon. Friend on bringing it forward. We have to make progress slowly, and we cannot always do as much as we wish. Nevertheless, one must be frank. The Bill does not deal adequately with this major problem.
What is the flaw in the Bill? Clause 1(2)(1A) says:
Where a person to whom section 29 of the National Assistance Act 1948 applies requests the local authority to make any of the arrangements mentioned"—
and I emphasise this point—
and the local authority accepts that such arrangements …
This provision in the Bill is applicable only where the local authority "accepts". But we are not concerned with those good local authorities which accept. We should be concerned with the bad authorities which do not accept. The essence of the


Bill is to speed up action where the local authority has accepted, but it is my contention that we should be more concerned to press those local authorities which are refusing to accept any kind of liability.
In the case of Mrs. Wyatt, when she made her complaint she was, in effect, told to push off. She was given nothing. The court told her that the only right she had was to go to the Secretary of State. The powers of the Secretary of State are sweeping. But because they are sweeping, he does not use them. He can only suspend the operation of the social services department of the local authority concerned. In my view, because this power has never been used, it is unlikely that it ever will be, because, once the Secretary of State intervenes, he may end up by running a large part of the country's social services himself. So the Minister understandably is relucant to use his powers, and it means that the individual disabled person can be ignored with impunity by a reactionary local council, and such a council is prepared to do that in the absence of any legal penalty.
The extent of the need for strong action by the Government is underlined by the latest figures, which I have. It is possible that my right hon. Friend the Minister with responsibility for the disabled will have more up-to-date figures. The bizarre patchwork of provisions by local authorities is scandalous. The latest information that I have shows that in the two years to 31 March 1977, Manchester installed 1,312 telephones, Wandsworth 1,020, and Solihull none, yet obviously the severely disabled people of Solihull needed that vital lifeline, the telephone, as much as people elsewhere.
We need new powers under legislation to impose duties on local authorities and to give rights to disabled people, because we have to ensure that the disabled individual who is neglected by his county council is able to go to a court of law under section 2 and say "I should like to see it implemented." Section 2 provides for the local authority to make arrangements in such matters as practical assistance in the home, television and radio adaptations, telephones and meals.
I have come to the conclusion that exhortation is unnecessary. The good

local authorities such as Manchester are doing what they are because they want to do it, and partly because of the provisions of the original Chronically Sick and Disabled Persons Act. The only hope of levelling up standards of provision across the country is by imposing far more serious obligations on local authorities than there are in the Bill. The Bill is a small and limited measure, and I hope that it will be extended.
When dealing with the disabled we sometimes tend to bring out the brass band to declare what we have done, followed by a crash of cymbals. Thereby, we may delude the public into thinking that all the problems have been solved. Even worse, we may delude ourselves and think that all the problems have been solved. That is the grave danger. We should put away the brass bands and the cymbals occasionally and recognise that a vast problem remains of gross discrimination against the severely disabled, and gross neglect by many wicked reactionary local councils. The councils will be dealt with only by tough, firm legislative measures. I hope that we shall be able to amend the Sill by imposing a clear duty on local authorities to provide facilities for the disabled and by giving power to the disabled to enforce their rights in a court of law.
I pay tribute to my right hon. Friend the Under-Secretary of State. He is never guilty of complacency. He is always emphasising the need for action. I recognise more than most the pressures that are upon him from the Treasury, and pressure should be brought by the House on the Treasury. At the same time, I assure my right hon. Friend and the Treasury that strong measures will be brought to bear on them, and equally on local authorities.
The Bill is welcome and I shall support and vote for it. I congratulate my hon. Friend the Member for Dearne Valley on bringing it forward. I hope that he will not take my criticisms amiss. They are meant to be constructive and not destructive.
This is the first time that I have spoken in the House since the new year. I add my voice to the congratulations that have been offered to my right hon. Friend the Under-Secretary of State on his elevation. It is much deserved. It is one that gives us all a great deal of


pleasure. It has been mentioned before, but I add my small voice to the many congratulations that my right hon. Friend has received, and I wish him well in future.

3.03 p.m.

Mr. Lewis Carter-Jones: I congratulate my hon. Friend the Member for Dearne Valley (Mr. Wainwright) on bringing forward an important Bill. It is a measure that we should have been ready to introduce in 1970. As my right hon. Friend knows, we began with a blank piece of paper in 1970 and we had to produce a Bill. From time to time since those days there have been amendments that have improved the original measure.
I accept the comment of my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) that sharper teeth in clause 1 would have been preferable. However, that is not to be. Although I do not go as far as my hon. Friend, I share his feeling.
By implementing the first amendment that the Bill seeks to introduce we shall be able to embarrass local authorities—and I mean really embarrass them. We shall be able to go for minimum recognised standards.

Mr. Patrick Jenkin: No. Adequate standards.

Mr. Carter-Jones: It may be that the Bill does not go as far as the right hon. Gentleman would wish. If that is his view, I am with him.

Mr. Jenkin: I should not have interjected from a sedentary position. I understand that the shorthand writers may want to know what I said. The Bill does not provide a minimum standard, which is something that I have long espoused as the right approach to be taken by the Government. I do not like the word "minimum". I wish to establish adequate standards, which may be set at a level commensurate with the money that is available. The Bill gives an automatic right to a client group to take a local authority to court. That is very different. As my hon. Friend the Member for Wallasey (Mrs. Chalker) said, we are looking forward to the Minister telling us how he proposes to reconcile that approach with, for

instance, the public expenditure projections that were published only a short time ago.

Mr. Carter-Jones: I am with the right hon. Gentleman all the way. As far as I am concerned, if the need is identified it must be implemented. The rate support grant is not sacrosanct. I do not know of any local authority that has refused money for a specific purpose or refused additional funds for the inner city areas. Local authorities have welcomed them. If a local authority has identified a need and cannot implement it, the rate support grant should be modified for a specific purpose. If I am on the Committee, I will go that far.
We are concerned with those who are worst off in our society. If we have identified the problem and the local authority does not have the money, we should augment the rate support grant. It is clearly stated that if the local authority has identified a need, the persons affected shall have the right to go to court. That is simple, ordinary justice for those in our society who are worst off.
Dealing with the section on public buildings, we have been previously told that we must recognise that local authorities may make their own decisions on planning permission. The assumption is made that access is available purely for people in wheelchairs. That is not true. The architects' attitude to steps is bizarre. Good access is not only for people in wheelchairs but for the mother with a pram, the elderly who walk with difficulty, and those with arthritis. It is not a minority group but a substantial number of people in our society. A step should not be built instead of a ramp, because that will cut off access to a public building for 40 per cent. to 50 per cent. of the population. We must get our priorities right. A building used by the public must have access for all.
The third amendment is modest, progressive and extremely simple. It is the provision of a toilet. Everyone in this House uses a toilet every day. There is no point in giving access to the elderly, the mother with a pram and the disabled if they do not have access to a toilet. It is a basic requirement that should be in the Act. It is a terrible thing that in 1979 we are still talking about providing


toilet access for the elderly, disabled, sick and infirm.
The fourth amendment is related to education. The disabled child faces a double handicap—the handicap or disability itself and the lack of opportunity to receive education. This is a perfectly straightforward, acceptable amendment, which should be viewed with favour in all parts of the House.
Also, there should be better opportunities for employment. For some years I have fought a battle on this. I do not think that the disablement resettlement officers in the Department of Employment or in manpower services have been as good or as effective as they should have been. This minor amendment assists that.
The final amendment concerns the question of the disabled child having the opportunity to reside with people of his or her own age group. That is vital. When we took the Act through in 1970 we thought that we had resolved this problem, but we had not. Unfortunately, there are still youngsters in geriatric wards. There are still young people who never see others of their own age. There are still youngsters who are not given the opportunities of education or employment. My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) stressed these points. This is a modest Bill, which will bring a better form of living to substantial numbers of people.
I recognise what the hon. Member for Wallasey (Mrs. Chalker) said. There is within the Bill the distinct possibility of vast public expenditure. I identify this and recognise it. But when we took the 1970 Act through I said that that measure, which went through Parliament without a vote being taken was a time bomb ticking away in the town halls of the country. Once the Bill was enacted, local councils of all persuasions should have been prepared to accept money for specific purposes to assist those who could not help themselves, despite the fact that they wanted to protect their own autonomy.

3.13 p.m.

Mr. Timothy Raison: I had not intended to take part in the debate, but in listening to hon. Members opposite I was struck by the implication that certain local authorities had failed to provide certain discretionary services.
The hon. Member for Stoke-on-Trent, South (Mr. Ashley) compared the Manchester authority with a number of others, very much to the favour of Manchester. I believe that there is a sound principle of government which says that income maintenance, where it can be identified, should be the prerogative of central Government. I do not think that local government should be involved in income maintenance. Personally, I do not think that local government should be subsidising bus fares or telephone services. These things should be done by central Government as a matter of principle and practice.
As a matter of principle, it makes for much better administration if one can say that local government is about services and central Government is about financial support. Generally speaking, this has been the rule, but it has been broken in a number of respects. When it is broken we run into trouble and get into a muddle. This does not make for very sound government.
I hope Labour Members realise that the way in which the rate support grant has been operating recently has been very unfair. It is not difficult for Manchester to provide good services, because it gets a great deal of money from the RSG. Other parts of the country are under very severe rate pressure indeed. This is the result of deliberate Government policy.
The Government are wrong, and I do not say that because I represent a shire county. The Government may be right to favour the urban areas and put rural areas at a disadvantage. That is a policy decision which they have made, but I beg the House to recognise the consequences. Those consequences can only be that urban areas which get beneficial treatment will be able to provide a better level of service than the rural areas which get adverse treatment.
That is an inescapable fact, though the hon. Member for Eccles (Mr. Carter-Jones) says that the answer is to manipulate the rate support grant and to include in it more tied services. I do not think that that is the answer, I believe that, in its way, the rate support grant, though it is not a perfect instrument, is the best that we are likely to get.
I believe that the answer is to take those services out of the purview of local


government, except perhaps for the shared business of administering them, and put them under the control of central Government. To be specific, such matters as the provision of telephones for disabled people should not be dealt with by local authorities. Such a service should be provided by the social security system and administered through its offices.

Mr. Carter-Jones: When the 1970 measure went through, I asked a question about the comparison of local authorities at that time. There were good and bad authorities, irrespective of which party was in Government.

Mr. Raison: That was not my point. The point I am making is that there is a strong preference on the part of Government, through the rate support grant, for certain authorities against others. Those authorities which are hard done by under the rate support grant will inevitably be less generous in the provision of discretionary services than those which get a lot of money.
There is no justice in that, because a poor person or a disabled person is just as poor and just as disabled if he lives in a shire county as if he lives in a big city. There is no logic in the situation where a poor and disabled person in a city should have available money which is not available to the poor and the disabled in the shire county.
I believe that the local government system and the rate support grant on which that system is based are the wrong methods for dealing with income maintenance.
If we could possibly transfer income maintenance back into the realm of central Government, I think that the disabled and the country as a whole would be much better off. Local government would then be able to get on with the very many services which are in its sphere.

3.19 p.m.

Mr. Allen McKay: I rise to support the Bill so ably moved by my hon. Friend the Member for Dearne Valley (Mr. Wainwright) and I have been pleased to place my name, with those of many other hon. Members alongside his.
I realise that there are many areas in which resources are urgently needed, but

there are people who sometimes believe that society has forgotten them and think that they are not being properly looked after. I have said on many occasions that the greatness of any nation will in the future be judged not by its material wealth or by its military greatness but by the use it makes of its resources to help those who cannot help themselves. There are bad and good local authorities.
The hon. Member for Aylesbury (Mr. Raison) has said that there are some functions which ought not to be carried out by local government. The reason why some of those functions are carried out by local government is that we have not carried them out here and have apparently not been able to carry them out at the level of central government.
Those local authorities have realised very quickly, and from the grass roots, the needs of the people they serve. I am proud of my association with an authority which runs a concessionary scheme throughout the whole county area and with a small authority, well known for the way it deals with social problems, which runs a television scheme.
I was privileged, some time ago, to attend a meeting in Huddersfield which was addressed by my right hon. Friend the Under-Secretary. At that time he was addressing meetings throughout the area explaining the contents of the Act in the hope that local authorities would carry out its intentions. I was impressed not only by my right hon. Friend's presentation of the Act but by the Act itself.
The amendments in my hon. Friend's Bill will serve to strengthen the resolve of my right hon. Friend. I believe that they accurately reflect the feelings of my hon. Friend the Member for Dearne Valley, who has endeavoured for so long to encourage local authorities to accept their responsibilities under the Act. Most local authorities, especially the Labour-controlled ones, honour to some extent the spirit of the Act. Some are better than others.
I know of many councillors who serve on social service and welfare committees who would like more resources to be diverted to the work of their committees so that the provisions of the Act may be effectively implemented. I believe that the amendments in the Bill will help that.
Local authorities have many commitments for their resources, and that means that there are always Cinderella areas. In the same way, Parliament has Cinderella areas, too. The areas that we are discussing today tend to get shoved to the back for consideration at another time, and that makes the amendments necessary.
It is essential for access to public places to be provided so that disabled people may be a part of society as of right. A couple of weeks ago one of my constituents, who is confined to a wheelchair and has no use in his legs, came to see me. By his own grit and determination he has succeeded in becoming a first-class motor mechanic. He is thus able to earn a living. But he cannot get into public offices, the library or various jobcentres. He asked me whether he did not have the right, in this society, to choose the books he wants to read and the education facilities that he requires.
The improvement of sanitation facilities is essential. This sort of problem was brought home to me when on one occasion I found myself locked out of my home. I am not disabled, so I was able to find other accommodation. A disabled person in that position would be in a desperate plight.
I support the provision in the Bill concerning the placing of young people into dwellings which are meant for senior citizens. I think that young people will already have suffered traumatically enough at being placed in residential care, without their being placed among people with whom they cannot communicate.
I realise that that subject probably trespasses on to questions of housing and other aspects of social services, perhaps involving an increase in domiciliary care. However, I believe that places could be made available for these groups, and I hope that the Minister will look at that.
I strongly commend the Bill to the House, and I hope that the House will support its Second Reading.

3.24 p.m.

Mr. Bruce Grocott: Like all the hon. Members who have spoken so far, I congratulate my hon. Friend the Member for Dearne Valley (Mr. Wainwright) on introducing the Bill. With so many specialists in this field present, I shall not try to trade with

them on the details of the Bill. I want to speak now because the organisation of our business has meant that my Bill, which concerns handicapped children, and which is fourth on today's list of Bills, is most unlikely to be debated. I hope and trust, however, that no one in the House objects sufficiently strongly to prevent its further passage.
My Bill relates to many of the matters about which my hon. Friend the Member for Dearne Valley is concerned. He specially mentioned, as did my hon. Friend the Member for Eccles (Mr. Carter-Jones), the importance of bearing in mind handicapped children and young people and the special problems that they face.
A responsibility is imposed on the rest of us to try to help people overcome the problems of their handicap. It must be a great shock to people in this country that we sometimes treat handicapped children in schools in a way we would not treat perfectly fit adults. It is still possible to use corporal punishment against handicapped children educated in special schools. They may be partially sighted children or mentally handicapped children. I have seen disturbing reports from psychiatrists explaining what, I suppose, is common sense, that when corporal punishment is administered to a mentally handicapped child, with a cane, slipper or other implement, the child is usually bewildered and has no idea why the punishment has been administered or what the punishment is meant to achieve.
I would have thought this was a matter of great concern. We are the only country in Europe, apart from the Republic of Ireland, which sees the need to beat children, including handicapped children, in order to help them develop their education. That is an indictment of our values. I would like to think that this country leads the way in some respects. On this issue, I only beg that the House should drag us up to the standards long accepted as minimal civilised standards in other European countries. This is particularly true when one considers the effects of corporal punishment—

Mr. Deputy Speaker (Mr. Bryant Godman Irvine): Order. Is this matter included in the Bill under discussion?

Mr. Grocott: I would have thought that it was very much included within the long title of the Bill, which is concerned to make further provision with respect to the welfare of chronically sick and disabled persons. I would have thought that a disabled child was a disabled person in need of the concern of this House, and that amendments to the Bill in Committee would take account of some of the points I have raised. I hope that that course will not be necessary. I trust that the feelings of decent people will be respected by hon. Members of this House and that there will be no objetcion when my Bill is presented later today.
If, however, some hon. Member was so out of touch with civilised opinion as to oppose my Bill, my hon. Friend the Member for Dearne Valley would be prepared to respect public opinion by amending this Bill to prevent the use of corporal punishment against handicapped children.
Among the many evil effects of the use of corporal punishment are the undoubted connections that exist between sex and violence. STOPP, the organisation of teachers opposed to corporal punishment, has in its possession some distressing and disturbing pieces of pornographic literature exclusively concerned with the caning of children in a school situation, featuring all the paraphernalia of the school as a backdrop, with the blackboard, the mortar board, the gown, and so on. The House and the country should be deeply disturbed about this clear connection between the use of violence against children, including handicapped children, and certain kinds of sexual deviation.
I appeal to my hon. Friend, who I know will be sympathetic, that we should try to bring this country into line with every other country in Europe, to respect public opinion and to clear up the anomaly of the present law which allows me as a teacher, or any other teacher, to strike a handicapped child a set number of times with a stick according to regulations of a local authority, although if I were to do the same to Muhammad Ali I would be liable to a summons for assault. Rightly so, for we cannot beat adults with sticks. But we can beat children with sticks, even if they are handicapped.
I appeal to my hon. Friend to amend the Bill so that this serious respect in which we fall behind the standards of both Western and Eastern Europe can be put right.

3.31 p.m.

Mr. David Weitzman: As one who played some part in the promotion of the Chronically Sick and Disabled Persons Act 1970, I am very interested in the Bill. Sections 1 and 2 of that Act laid a mandatory duty upon authorities with regard to the register and the services to be provided. We described that Act as a charter for the disabled, and I am sure that it was.
Whatever criticism may be made about where the duties should lie—whether with local authorities or with central Government—these are important duties which should be carried out. But there are difficulties. The first is that a number of local authorities have not properly tried to carry out their duties. Many have been negligent. I do not want to Rive names, but hon. Members probably know to what I am referring. There is also a difficulty over money, but surely something should be done to ensure that a mandatory duty is carried out effectively.
My hon. Friend the Member for Dearne Valley (Mr. Wainwright) is to be congratulated on having suggested in the Bill a machinery for this purpose. The only flaw is the reference in the suggested new subsection (1A) to the local authority "accepting" such arrangements. There may be a weakness in what is meant by "accepting".
But it is essential to have machinery for ensuring that local authorities accept their duties, and where they do this my hon. Friend has sought to provide machinery for enforcing this by allowing someone to obtain an order from the county court. Subsections (3) to (7) of clause 1 put a duty upon the Secretary of State to consider what further improvement could be made in access to schools and other premises and in providing sanitary conveniences needed by the disabled. The present arrangements should be continually studied and improved, and that duty is laid upon the Secretary of State.
Clause 2, which deals with elderly people, is also important. Elderly people should be dealt with in company with persons of their own age and not with much younger people.
This is a good Bill, which supplies a real need. I congratulate my hon. Friend on its presentation and hope that it will have a speedy passage to the statute book.

3.35 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris): I warmly congratulate my hon. Friend the Member for Dearne Valley (Mr. Wainwright), first, on his good fortune in the ballot, secondly, on his humane and felicitous choice of subject, and, thirdly, on the speech with which he commended his Bill to the House this afternoon. I have known my hon. Friend for many years and know well of his particular concern for disadvantaged people in our community and for the disabled in particular. It is a concern which I know is shared by right hon. and hon. Members on both sides of the House.
We are all especially pleased to have heard from my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). He speaks with great authority on the subject and represents many others as chairmen of the all-party disablement group in this House. The hon. Member for Wallasey (Mrs. Chalker), my hon. Friend the Member for Eccles (Mr. Carter-Jones) and my hon. and learned Friend the Member for Hackney, North and Stoke Newington (Mr. Weitzman) are listened to with much respect in any debate on the claims of the disabled. I was naturally interested to hear the speeches of my hon. Friend the Member for Penistone (Mr. McKay) and my hon. Friend the Member for Lichfield and Tamworth (Mr. Grocott).
I am glad to be able to say that the Bill has, in principle, the support of the Government and that parliamentary counsel will be available to help in ensuring that its drafting is sound. I shall also be arranging for consultation with the local authority associations. Those are both matters that were raised with me this afternoon.
The provisions of the Bill extend to Scotland, Wales and Northern Ireland as well as to England. While Government

support will be accorded to it in principle on that basis, my right hon. Friend the Secretary of State for Scotland will be asking the Scottish parliamentary draftsmen to undertake those aspects of the preparation of the draft which are affected by existing Scottish legislation. He will also consult the Convention of Scottish Local Authorities in the matter. In the case of Wales, my right hon. and learned Friend the Secretary of State for Wales will be maintaining close contact with us over the drafting of the Bill. The Secretary of State for Wales will also be arranging for consultation with the local authority interests in Wales.
My hon. Friend the Member for Dearne Valley has set out the benefits which he expects the Bill to confer on disabled people. As I have said on many occasions, my own concern over the years has been to argue not for litigation but for full implementation of the Act. I have never seen the judge as some kind of saviour or ayatollah of the disabled. Nor, in promoting the Act, did I ever wish to create a new light industry for lawyers. What clause 1 of the Bill will do is to bring the law into line with what was always thought to be the effect of section 2 of the parent Act. I believe it will be helpful, but we should not expect too much from legal intervention.
Authors are often the sternest critics of their own work. I would be the last to claim that the Chronically Sick and Disabled Persons Act was perfect. As my hon. Friend said, it has been strengthened and extended on many occasions already, and I hope that as opportunities allow we shall be able to build further upon the foundations that were laid in 1970. Of course, the Act can be further strengthened to the advantage of disabled people, and that is the purpose of today's Bill. As my hon. Friend has indicated, he, too, believes that political action on behalf of the disabled in the localities is no less important than litigation.
Today's debate gives me the opportunity briefly to review some of the progress that has been made since the 1970 Act became law.

Mr. Patrick Jenkin: The Minister appears at this point to be departing from discussion of the Bill. Will he say something about the question of finance, whether a money resolution will go down,


and whether additional money will be made available to meet the costs of implementing the Bill?

Mr. Morris: I am not departing from the provisions of the Bill. I was about to say a brief word about the progress that has been made since 1970.
The right hon. Gentleman raised the question of finance. His hon. Friend the Member for Wallasey asked me about the help of parliamentary draftsmen. All I can say at this stage is that we shall give the wording of the provision very careful attention.
The hon. Member for Aylesbury (Mr. Raison) used some very loose language. He spoke of discretionary powers in the Act. There are mandatory powers in the Act. I have been beside myself in the House on many occasions to emphasise that when a local authority has identified and accepted a need, it shall be the duty of the authority to meet that need. That is the legal advice available to me. I have to be extremely careful at this stage, as the right hon. Member for Wanstead and Woodford (Mr. Jenkin) will appreciate. I have said that I will be in touch with parliamentary counsel on the matter. There will therefore be a further opportunity to look at the effect of the provision as it emerges from the consultations of which I have spoken.
I was reviewing progress since 1970. First, as my hon. Friend said, it is worth recording that well over 1 million people have been helped individually by the Act in their own homes. Millions more have been helped indirectly by improved access to public and social buildings and by the more general provisions of the Act.
Today's debate gives me the opportunity briefly to review some of the progress which has been made since the 1970 Act became law. I should like to touch on not only provision of services under that Act but the broader purpose of improving the quality of disabled people's lives and the equality of their opportunities at leisure and at work, for, as my hon. Friend said, there is only so much that legislation alone can achieve. Changing attitudes is also deeply important.
I refer first to the effect of the Bill itself. The House will be aware that I

share my hon. Friend's concern about disparity in provision of services. I am particularly concerned by the sort of case where a local authority has fully accepted that a disabled person is in need of a particular service, for example, an adaptation to his home, yet where months go by and the authority apparently takes no steps to meet the need even although it has accepted its existence.
It is in precisely these cases that I believe that my hon. Friend's Bill will provide the remedy which is required. The Bill will not, of course, provide a panacea for all the problems of disabled people in need of services. But I believe that, where there are glaring instances of apparently indefensible dilatoriness, which are the ones that all too often come to my attention, the Bill should provide a real solution. It will also restore the position to what, until last year's Court of Appeal judgment, disabled people and those of us who are identified with their interests had always supposed it to be.

Mr. Raison: I accept the right hon. Gentleman's rebuke about my somewhat loose language, but could he touch on a crucial part of the argument, which is what happens to those local authorities which are simply getting nothing like as much money from central Government as they need? How are they to pay for all the things that we all agree should be done? Why cannot the central Government take over the burden?

Mr. Morris: There are disparities in provision as between local authorities of the same kind. The hon. Gentleman's argument is that the disparities flow from the fact that there are different financial provisions for different kinds of local authority. I cannot detain the House with figures, but I point out that there are substantial disparities as between local authorities of the same kind. Manchester has been referred to kindly in the debate. There are other great urban authorities which are not doing nearly as well as the city of Manchester.
I have mentioned my concern about disparity in provision, and none of us can afford to be complacent about the position. Yet it may do no harm, for once and if only for a moment, to focus on the good news, which is that there has been considerable progress, both in numbers of disabled people registered and


in the provision of services for them, not only over the nine years since the Act was passed but also within the last year.
I was greatly encouraged to see, in the issue of the British Medical Journal of 20 January, an editorial about disabled people entitled "Are they being served?" It included a reference to the figure from the Amelia Harris survey of 1·1 million handicapped adults in the community.
In this regard, the House will be interested to learn that the figures of disabled people registered by local authorities for the year 1977–78 are just becoming available. They have not yet been published, but I can say already that the provisional figure for the number of registered disabled people in 1977–78 was almost exactly 1 million, as compared to only 405,000 in 1970 and 917,000 in 1977. We are, therefore, now very close to the figure quoted in the BMJ article.
The number of households receiving help with telephone installations and rentals increased by 7 per cent. in the last year. Thus, there is now a total of 92,581 such households, compared with 29,617 in 1973. The number of adaptations to homes—an essential factor in ensuring disabled people can remain independent and in the community—increased by 13 per cent. in the last year. Over 59,000 households underwent such adaptations in 1977–78, compared to 28,374 in 1973. Some 218,400 personal aids were provided last year, compared to 118,211 in 1973. These figures are encouraging although, as I have said, there is a very great deal still to do. My Department is attempting, through a small research study, to gain information about the significance of the variations in services provided by local authorities. We hope this will give some explanation of those factors which bear on provision and which cannot easily be accounted for.
I remind the House that the Chronically Sick and Disabled Persons Act was the product of a great deal of working together by both sides of both Houses of Parliament. Again, I pay tribute to those on both sides of the House who have dedicated themselves to seeing that the Act is fully and humanely applied.
I turn from the provision of personal social services to other essential action to enable disabled people to take their rightful place in society, by which I mean on equal terms with the able-bodied. In particular, at the moment I have in mind what has been done, and what still needs to be done, to improve access for disabled people to public and social buildings.
I am very glad now to have received the report of the Silver Jubilee committee on improving access for disabled people, which I set up in 1977 to look at the problems which disabled people have to face in getting about, to recommend changes to the responsible authorities and to consider ways of improving public attitudes in favour of the disabled. The membership of the committee included perhaps the most representative group of disabled people ever brought together. Many of their recommendations are both hard-hitting and far-reaching. My colleagues and I will be considering the committee's very important conclusions, so far as they relate to central Government, at once urgently and sympathetically. I hope and believe that both local authorities and the voluntary organisations will do the same.
All too often, disabled people are still made to feel that they are second-class citizens. Owners and managers of public and social buildings all too frequently fail to take the needs of disabled people into account. But we are beginning to get the "access" message across. In this respect, the Silver Jubilee committee's report is a landmark. The committee's central message is:
In a civilised society disability should not just be a problem for disabled people.
It is up to each and every one of us to ensure that disabled people can go where we go and also that they are accepted when they get there.
One of the most important of this Silver Jubilee committee's recommendations was that a successor body should be set up to carry on the fight. We have accordingly set up a new committee on restrictions against disabled people. This will be chaired by Mr. Peter Large, who was such an able and effective chairman of the Silver Jubilee committee.
The new committee's terms of reference will be to consider the architectural and


social barriers which may result in discrimination against disabled people and prevent them from making full use of facilities available to the general public, and to make recommendations. In carrying out its work the committee will, of course, recognise and take careful account of the interests of other governmental advisory bodies, such as the National Council on the Employment of Disabled People. I shall keep in mind the suggestion made by the hon. Member for Wallasey that I should make a further statement about the new committee as soon as possible.
Another area in which more can be done without necessarily introducing further legislation or significantly increasing expenditure is the provision of better information for disabled people about the services and benefits available to them, both from central and local government and the voluntary sector. Often the sheer multiplicity of sources of help can be confusing, and we are, in a sense, victims of our own virtue. The more services and benefits we provide, the more complex the system becomes. We all want simplicity, but we cannot ignore the fact that the needs of the disabled are complex. Because help in meeting these needs is given both nationally and locally, there is a limit to what can be done centrally to inform disabled people of what is available to them.
With this in mind, my Department is constantly looking at ways in which the dissemination of information to disabled people can be improved, not only nationally, but locally. We are currently supporting two research projects to evaluate different forms of local information services, and I shall be studying the results with keen interest. The BMJ article, to which I referred earlier, makes some very valuable suggestions about the need for better communication systems and for improving the disseminating of information. I am following these up and hope that it may be possible to act on some of them in the near future.
Also on the subject of communication, a recent initiative—which cost little, but should give important help to disabled people whose needs are often forgotten—gave me particular personal pleasure, as I know it did the right hon. Member for

Wanstead and Woodford. That was the national competition in which my Department worked with the Royal National Institute for the Deaf to find a symbol for the deaf for display in public places, in much the same way as the wheelchair symbol is now used for physically disabled people, to indicate that inquiries from people disabled by deafness will be met with an understanding and helpful response. The results of this competition were most encouraging, as the right hon. Gentleman saw when he attended the Royal Academy on the occasion of the presentation of the prizes. I hope to see the winning symbol becoming widely known and playing its part in alleviating the invisible but severe and isolating handicap of deafness.
I have referred to one or two of the more recent steps my colleagues and I have taken to complement the personal social services provided for disabled people under the Chronically Sick and Disabled Persons Act. One thought which always has to be in the forefront of our minds is the need to achieve the right balance between cash benefits and services. I am glad to say that cash benefits for disabled people have also significantly improved over recent years.
For example, there are half a million people now receiving invalidity benefit and, over the past few years, the rate of benefit they receive has improved in real terms.
In addition, we have introduced three brand new cash benefits. First, we now pay the non-contributory invalidity pension to over 100,000 men and single women who cannot work and have never been able to earn their own living. This has recently been extended to tens of thousands of married women who cannot work or look after their homes.
Second, we have introduced the invalid care allowance for the man or single woman who stays at home to care for a handicapped relative. Both these new benefits go to people who previously had to rely on means-tested help.
Third, we now provide the mobility allowance to help severely disabled people who are unable, or virtually unable, to walk. This gives a cash grant to very large numbers of disabled people who had no mobility help at all under the old scheme. We recently extended the


age limits for the allowance, and it will eventually be available to 145,000 people. This new help, backed by the work of the new voluntary organisation—Motability—will do a great deal to help the severely disabled to get out and about. In all, spending on benefits for the sick and disabled in 1978 was nearly £400 million higher in real terms than it was in 1974.
The right hon. Member for Wanstead and Woodford explained what he wanted to see in terms of provision for disabled people. He thought that the provisions should not necessarily be through local authorities but through central institutions. There is already a great deal of provision from central institutions. Local authorities have their part to play, because they are much closer to disabled people than anyone in Government. The voluntary sector also has a vital role in this area.
For the future, there are many other initiatives on behalf of disabled which the Government want to help forward. We shall not be content until disabled people are fully integrated into our society and can enjoy the same opportunities as the able-bodied. One opportunity to hammer this conviction home will be provided by the international year for disabled people in 1981. We were one of the sponsors of the United Nations resolution on the year and we intend that the United Kingdom shall play its full part at all levels.
I am quite certain that the hon. Member for Aylesbury and all his parliamentary colleagues will be as anxious as we are to see that Britain plays a leading part in the activities of the international year for the disabled.
Government initiatives need backing up by the day-to-day concern of society at large. I hope that today's debate will go further to improve the well-being and status of disabled people. That is the intention of this Bill. I urge hon. Members to give it their support today.

Mr. Patrick Jenkin: I can assure the hon. Member for Dearne Valley (Mr. Wainwright) that I have no intention of talking out his Bill. Let there be no doubt about that. I simply wish to put one question to the Minister which I have put previously. The Minister uses the formula of referring the Bill to parlia-

mentary counsel and taking their advice. Will he now say that, if—as a result of the advice of parliamentary counsel—additional expenditure will be involved, it will be the Government's intention to table the necessary money resolution and introduce the necessary Supplementary Estimates to provide for that expenditure?

Mr. Alfred Morris: This is the Second Reading. I have explained that I am meeting the request of the Opposition that parliamentary counsel be asked to look at the provisions of the Bill. There was a money resolution attached to my measure in 1970 which dealt with section 2 of the Chronically Sick and Disabled Persons Act. I have explained that the hon. Member for Aylesbury was in serious error when he ignored the mandatory nature of section 2. That section makes it absolutely clear, as I am advised, that if a local authority identifies and accepts a need, it shall be the duty of that local authority to meet that need.
I am fully aware of the concern of the right hon. Member for Wanstead and Woodford. I hope that he will accept that I shall have all that has been said this afternoon very much in mind and shall see that we get the best possible advice from parliamentary counsel about the nature of the drafting. If there are problems that are then needed to be none into further, there will be other opportunities, I am quite sure, for the House to go into them in considerable detail.

Question put and agreed to.

Bill accordingly read a Second time.

Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).

Orders of the Day — REPRESENTATION OF THE PEOPLE (AMENDMENT) BILL

Order read for resuming adjourned debate on Second Reading [19 January].

3.58 p.m.

Mr. Nicholas Edwards: On a point of order, Mr. Deputy Speaker. The Minister was speaking when the Bill was talked out on the last occasion. I hesitate to rise because I do not know whether that speech is to be continued. If it is in order for me to continue, I shall


do so, in the brief minute or so that is available.
The prime object of the Bill is to ensure that those who are on holiday have the opportunity to vote in elections. The Bill seeks to remove the obligation on those who are married to Service people to register as Service voters. That they should be recorded on the register as Service voters causes a certain amount of distress and objection.
These seem to be worthy and valid reasons for changing the law. A great deal of distress is caused at present because people who are away on holiday are not entitled to vote. I believe that the House should support this measure.

3.59 p.m.

The Under-Secretary of State for the Home Department (Dr. Shirley Summer-skill): As the hon. Member for Pembroke (Mr. Edwards) said, my colleague the Minister of State was speaking to clause 1 of the Bill when the debate was adjourned. He was in the process of saying that the clause widened the criteria set out in the Representation—

It being Four o'clock, the debate stood adjourned.

Debate to be resumed on Friday next.

Orders of the Day — HANDICAPPED AND DEPRIVED CHILDREN (ABOLITION OF CORPORAL PUNISHMENT) BILL

Order for Second Reading read.

Hon. Members: Object.

Mr. Bruce Grocott: On a point of order, Mr. Deputy Speaker. You will recall that two weeks ago, when this Bill was objected to, it was objected to by the hon. Member for Cheadle (Mr. Normanton). who on this occasion has been prudent enough not to put in an appearance—

Mr. Deputy Speaker (Mr. Bryant Godman Irvine): Order. That is not a matter for the Chair.

Mr. Grocott: Further to that point of order—

Mr. Deputy Speaker: There is no point of order.

Mr. Grocott: Then, on a new point of order. It concerns the openness of this House to the public outside. In view of the widespread revulsion that there is about this—

Mr. Deputy Speaker: Objection taken. Second Reading what day?

Mr. Grocott: Friday 6 April.

Second Reading deferred till Friday 6 April.

Orders of the Day — REPRESENTATION OF THE PEOPLE (ARMED FORCES) BILL [Lords]

Order for Second Reading read.

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day?

Mr. John Wells: On the instructions of the hon. Member in charge of the Bill, Friday 16 February.

Second Reading deferred till Friday 16 February.

Orders of the Day — MERCENARIES BILL

Order for Second Reading read

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day?

Mr. Nigel Spearing: On the instructions of the hon. Member concerned, Friday 23 February.

Second Reading deferred till Friday 23 February.

Orders of the Day — HOMEWORKERS (PROTECTION) BILL

Order for Second Reading read

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day?

Mr. John Tilley: On the instructions of the hon. Member in charge of the Bill, Friday next.

Second Reading deferred till Friday next.

Orders of the Day — NATIONAL HERITAGE FUND BILL

Order for Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday next.

Orders of the Day — PUBLIC BODIES (APPOINTMENTS) BILL

Order for Second Reading read

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day?

Mr. John Wells: On the instructions of the hon. Member concerned, Friday next.

Second Reading deferred till Friday next.

Orders of the Day — COMPANIES (DISCLOSURE OF AUDITORS'SHAREHOLDINGS) BILL

Order for Second Reading read.

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day? No day named.

Orders of the Day — WATER SERVICES CHARGES (REBATES) BILL

Order for Second Reading read.

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day? No day named.

Orders of the Day — LEAD CONTENT OF PETROL BILL

Order for Second Reading read.

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day? No day named.

Orders of the Day — CO-OWNERSHIP OF FLATS BILL

Order for Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday 23 February.

Orders of the Day — STOKE MANDEVILLE HOSPITAL

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Graham.]

4.3 p.m.

Mr. Timothy Raison: The subject that I wish to raise today is that of the current grave conditions at Stoke Mandeville hospital. I say straight away to the Minister that, for once, the subject that I raise, although a health matter, has nothing to do with industrial action. I want to draw attention to a very different anxiety.
The House knows that Stoke Mandeville hospital is synonymous with the treatment of spinal injuries. However, I must make the point here and now that, although the treatment of spinal injuries is a very important part of the work of the hospital, it is only a part and that the hospital carries out the normal vital activities of a district general hospital, in the course of which it does some very distinguished work, which is also jeopardised by what is going on there at present. However, I intend to concentrate to some extent on the spinal injuries side of the hospital's work.
As it happens, last night there was a party at Stoke Mandeville to celebrate the thirty-fifth anniversary of the admission of the first patient on the spinal injuries side in 1944. It was held in the stadium for the paralysed and other disabled, and this stadium is really a monument to much that is best in our life here in this country.
As the Minister no doubt would expect, it was in many ways a cheerful party, as I think is any function that takes place in the stadium. It is a place that we should visit if we want to know about the indomitable spirit of men. Behind that spirit lies the peculiar achievement of Sir Ludwig Guttmann and his successors.
There was a somewhat sombre and ironical background to the party. Sir Ludwig spoke, and said that he had recently been to the opening of a new national spinal injuries centre in Israel. He had to make a contrast between that apparently splendid new set-up and the sad physical conditions at Stoke Mandeville.
I shall tell the Minister a little about what has been happening at Stoke Mandeville hospital in the past week or two. I have been told by the district administrator, who does an excellent job, that four wards are closed because of problems in the supporting structure for the ceilings. Since the bad weather at the beginning of January there have been numerous problems with the freezing of the water service and subsequent bursts.
During the weekend of 13 January a spinal ward had to be evacuated because of water coming through the ceiling. On 17 January attention was drawn to sagging of ceilings in that and other wards in the National Spinal Injuries Centre. As a result of an immediate inspection by the building officer, three further wards were taken out of use. Of the four wards that are out of use, three are spinal wards and one is a geriatric ward which happens to be housed in the spinal unit corridor.
Arrangements were made for patients to be evacuated to other accommodation. It was fortuitous and perhaps ironical that because of nursing shortages in the remainder of the hospital there were two wards closed on the general corridor, one general surgical and one general medical. The wards were used one for spinal patients and one for geriatrics. Other spinal patients were accommodated in other parts of the National Spinal Injuries Centre, some of that accommodation being extremely inadequate. The sanitary annexes of the general wards are entirely unsuitable for paraplegic patients. That is an important matter, which has been referred to in an earlier debate.
That is the sombre picture at an institution that has a fame that is unquestionably world-wide. The only bright spot is that after these happenings took place and the ceilings showed trouble there has been a first-rate effort on the part of all concerned, including the unions,

to take emergency steps. A number of persons have commented on the high state of morale that has been in evidence in the hospital in dealing with these serious problems. Even so, patients are having to wait for admission.
I have been asked to say by the chairman of the spinal injuries unit that it is felt generally at the hospital that although the troubles are real and serious spinal injury patients in other areas who need admission to specialised care should not be put off by what is happening. The special expertise accumulated at an institution such as Stoke Mandeville is extremely important.
Patching-up work on the wards is proceeding. However, more radical action must be taken by the Government as a matter of great urgency. The buildings in which the spinal injuries unit is housed are long past what must have been their expected life, when they were erected during the war to deal with the possibility of a large influx of wartime casualties.
It is not merely a spinal injuries problem. Other wards are in the same decaying condition. Obviously, the spinal injuries unit must not draw off an unfair share of resources from other parts of the Aylesbury hospital complex.
It is not only a matter of the ceilings caving in at Stoke Mandeville. There are other defects that must be overcome, including the heating service pipes in the wards, which are old and must be replaced, the lagging, which must be renewed, the energy conservation measures, which must be improved, and the electrical services, which must be rewired. More importantly, I am told that the main engineering distribution services to the whole hospital have been deteriorating over the years. The cost of renewing these will be substantial and will strain the scarce resources. There are many difficulties with the boiler system.
Money is vital to meet this need. Where will the money come from? I believe that this can only be dealt with as a national problem. As far as the spinal injuries side is concerned, we are talking of an institution known as the National Spinal Injuries Centre. It is not the only centre that we have in the United Kingdom but it is the only one in the South of England. It therefore plays far more than a regional role. It is a


national institution in that sense and in the sense that it is known throughout a large part of the world as one of the areas where British medicine has achieved great triumphs. Although there is to be a further institution at Odstock, that is still some way off.
In spite of that, we have seen a reduction in the number of beds in the hospital for spinal injury patients from 196 in 1966 to 156 today. Not all the beds are in use, due to staff shortages. It is not only a building problem. There is a shortage of nurses, although it is not grave, but there are other serious shortages. There is a shortage of physiotherapists, who have a particular role to play in the treatment of spinal injury patients. There is a shortage of medical social workers, which is partly due to the financial position of the county council. These workers are of great importance in the delicate operation of returning people with spinal injuries from hospital to the community.
Capital and revenue are needed. On revenue, the Minister will recall that about a year ago he visited Stoke Mandeville and was told of the problems. Following his visit, it was agreed that there should be a change in the formula by which money was allocated to regions and areas and that a special spinal weighting factor should be introduced to provide more money. It was expected that this new factor would produce an additional £400,000. None of this money has appeared, and the staff at Stoke Mandeville are anxious to know what has happened to it. There is a horrible feeling that none of this money will appear. Although the notional allowance has been made, the Oxford region is spending up to its so-called RAWP level and the £400,000 is a mythical book-keeping transaction. In other words, the decision in practice was meaningless.
My main point concerns the building programme. Should we go on patching up indefinitely an old building, or can we go all out for a new building to be erected as soon as possible? That is bound to take time, probably four or five years. But until 1974 such a building was firmly in the programme. Since then it has had to be taken out. I hope that the Minister will say when we can expect the new building and whether the Government will

provide funds for it. In providing funds, it must be made plain that we are talking of a national institution.
The region has other great calls on its resources, and it is not possible for it to find this extra money. It has to make hospital provision for the growing city of Milton Keynes. That is siphoning off a good deal of money which one hopes might otherwise have been available for Stoke Mandeville. Of course Milton Keynes must have hospital provision, but somehow or other the Minister must take on board the crucial need to provide additional funds.
In doing this, the Government should accept the responsibility for the fabric of the new building. Perhaps we should look to other sources of revenue. For example, the case of setting up a research unit under the auspices of the Medical Research Council is a very good one and I should like the Minister's comments on that as a source of additional money.
If the Government will come forward with money on an effective scale, I have no doubt that the great army of well-wishers of Stoke Mandeville would also chip in with money themselves. We could get a good fund-raising effort going to match anything the Government could provide. But the Government must provide. They must realise that this is a place of national importance and that it requires a national contribution to get it back on its feet.
I hope that the Minister will make an affirmative statement that he sees this as a matter of national importance. I hope that the spirit that has always permeated Stoke Mandeville, ever since Sir Ludwig Guttmann founded the spinal injuries unit—"We will not take no for an answer"—will not be lost on the Minister and that we shall get a response from him worthy of this important matter.

4.16 p.m.

Mr. Lewis Carter-Jones: I should like to identify myself totally with the remarks of the hon. Member for Aylesbury (Mr. Raison). In my role as British chairman of Rehabilitation International, I have been impressed in my trips round the world by the esteem in which Stoke Mandeville is held by people who were trained by Sir Ludwig Guttmann years ago and who have named


wards after him and after Stoke Mandeville. It is sad to see what excellent buildings those people have and how grateful they are to Sir Ludwig and Stoke Mandeville for their training.
As the hon. Gentleman said, this is a national institution capable of great work. There are easily obtainable solutions along the lines that he suggested. I hope that the Minister will give his full backing to the rejuvenation of the buildings, premises and facilities at Stoke Mandeville.

4.17 p.m.

The Minister of State, Department at Health and Social Security (Mr. Roland Moyle): I am grateful for this opportunity to say something about the backlog of maintenance work at Stoke Mandeville and the measures being taken to improve the situation, because this is a matter of great concern to the people of North Buckinghamshire, to the nation and, to some extent, internationally. I have no hesitation in saying that I can put my support entirely behind measures to renovate Stoke Mandeville. Of course, how we do it is another matter altogether.
Stoke Mandeville is mostly hutted accommodation dating from the early 1940s. It has the National Spinal Injuries Centre there, but it is also a district general hospital. The intention of the Oxford regional health authority and its Buckinghamshire area health authority is that there should be a phased replacement of the accommodation as part of a process of developing Stoke Mandeville as a district general hospital. A new wing of about 100 beds was constructed in 1975. The next major capital development on the Stoke Mandeville site—the hon. Gentleman particularly inquired about this—will begin in 1985–86. This will be the second phase of the district general hospital and at today's prices will cost £1·8 million.
I shall come back to the building and maintenance work, but there is no doubt that Stoke Mandeville is under heavy pressure because of expanding population in the northern part of Buckinghamshire, associated with the new town of Milton Keynes, which, pending the development of its own hospital facilities, depends upon Stoke Mandeville and Northampton.
There was a proposal from the health authority to reduce the number of beds devoted to spinal inqury patients, and it was in connection with that that I visited the hospital in April of last year. I rejected that suggestion because there remains a shortage of spinal injury beds in the South of England. This is another cause for the strain being placed upon Stoke Mandeville. However, the shortage of beds will be ameliorated by two new specialist units to be built, one for the Odstock hospital in Salisbury and the other at the Royal National orthopaedic hospital at Stanmore.
As for the pressure from Milton Keynes, a new purpose built 102-bed community hospital for the town will come into use later this year, and that should provide a little immediate relief. Later, there will be the 260-bed first phase of the Milton Keynes district general hospital, which should come into operation at about the middle of 1984. That will provide further relief for the pressure on Stoke Mandeville and Northampton.
In anticipation of this eventual replacement, there is no doubt that the authorities have attempted to minimise all maintenance costs in recent years, particularly in view of the claims of other hospital building and capital projects in the region. It has now become increasingly clear—the current incidents have dramatised this—that substantial expenditure will be necessary to maintain existing buildings.
The Buckinghamshire area health authority has been aware of the maintenance problem at Stoke Mandeville for some time. For example, in May last year the area works officer placed a report before the authority saying that the hospital's roofs required attention, that the boilers and associated plant would have to be replaced over a period of time, that part of the gas supply needed to be renewed and that some wards needed to be rewired and upgraded. Although the process had already begun at that time, this maintenance work is estimated to cost a little over £2 million out of an estimated maintenance work bill for the whole county on hospitals of about £3·5 million.
The maintenance backlog at Stoke Mandeville was brought sharply into


focus last month when, as a result of the bad weather, some water pipes burst and brought down sections of the ceiling in three wards in the National Spinal Injuries Centre and in one geriatric ward. At the same time it became evident that the roofs of a number of other wards would need early attention because of problems associated with the deterioration of the supporting joists.
The four wards immediately concerned have been evacuated and the necessary repair work has already been set in hand. The health authority expects that patients will be able to return to these wards fairly soon. In the meantime, the 75 or 80 patients involved have been transferred to other wards in the hospital. None has had to be transferred to another hospital or sent home.
A press statement was issued by the Spinal Injuries Association on Monday. The basic facts in the statement are correct, but the slightly passionate conclusion that there were no beds and few amenities for the patients and staff, with little hope of any immediate change, and that the hospital was being starved of money is obviously untrue against the background of the facts as I have stated them.
Work on the wards is well on the way to completion. They should soon be reoccupied by patients. In 1977–78. £375,000 was spent on maintenance of Stoke Mandeville. That was more than half the health district's expenditure of £716,000, and it is estimated that a further £430,000 will be spent in 1978–79 out of the maintenance budget of £810,000.
There has been a certain amount of public confusion in the matter. For example, there was a reference to this problem on the "Thames at Six" television programme which was screened on Wednesday evening. Here again, the facts are correct but they should be put in context. Doctors who were interviewed referred to a halt of non-emergency admissions, reduction in emergency admissions and the problems of patients who had to wait in other hospitals before they could come to Stoke Mandeville. This is correct, but these are longstanding problems resulting from the intense pressure to which Stoke Mandeville is subjected—as a result of the shortage of spinal injury beds in the South of England and the pressures of

the growing town of Milton Keynes. They do not have any direct relationship with the recent maintenance problems to which I have referred.
I should like to set out in greater detail the various developments and improvements which the health authorities plan to carry out at Stoke Mandeville, in addition to the major redevelopment in the mid-1980s to which I have drawn attention. These are already outlined in the capital programme of the regional health authority, drawn up in 1978. One of the hospital boilers has been replaced and a second is being replaced. A third will be replaced in the near future. Work on upgrading the laboratory started in June last year and should be completed in May this year. The other principal work on the building site is the construction of a 40-bed geriatric unit which was started in July 1978 and is scheduled for completion in July this year, although that will not be an additional source of beds. The beds will be used to provide acute geriatric services for patients who will be transferred from the nearby Tindal hospital. Although these beds will be additional on the Stoke Mandeville site, the number of geriatric beds in the district will not be increased.
The hon. Member for Aylesbury (Mr. Raison) referred to the hospital engineering services. The sum of £200,000 is to be spent on these and work is planned to commence in the financial year 1979–80. There is an extension planned to the kitchen but I understand that the district management team has recently suggested that the renewal of the hospital's electrical mains distribution system should take precedence. Area and regional health authorities will have to consider that problem and decide which is the most important priority. The hospital pharmacy will have to be upgraded, starting in 1981–82, to play its part in taking the additional workload off the Milton Keynes district general hospital when that comes on stream in 1984.
The hon. Gentleman asked whether the Department should make special additional funds available for Stoke Mandeville hospital. It was the crucial part of his case. There are two arguments. The first concerns the need to deal with the backlog of maintenance.
I do not consider that it is appropriate to make available to health authorities


special additional finance to enable them to overcome particular local problems of that nature. I do not see why the policy should be changed in the case of a backlog of maintenance at Stoke Mandeville. Maintenance work is fairly predictable and financial planning, budgeting and programming should take account of it. Contingency funds for these purposes are not held centrally. It is for the Oxford regional health authority and the Buckinghamshire area health authority to provide for the maintenance requirements at Stoke Mandeville, as at other hospitals, from their capital and revenue allocations.
The Department does not hold any money back, apart from some small grants for research purposes. It hands all its money to the regional health authorities on the basis of the resource allocation working party formula. The regions are expected to provide the appropriate money to the areas within their boundaries on the same principle. The authorities are free, within those budgetary limitations, to apply the money as they think fit to provide the service for which they are responsible. This provides a way in which management is given the maximum freedom to manage locally, subject to general guidelines from the Department and the budgetary limitations on funds. They must provide for maintenance out of those funds.
The other argument is that the Stoke Mandeville spinal injuries unit is a national centre of excellence and therefore should be nationally financed. This is an argument that could apply to several hundred other units in the NHS. To the extent that any specialist unit is involved in treating patients from outside the region—and in this case it is to a considerable extent—an appropriate annual addition is made to the region's target revenue allocation calculated in accordance with the criteria laid down by the RAWP.
Patients who flow in to Stoke Mandeville from outside the Oxford region are regarded as Oxford region patients and

are funded according to the formula. This influences the actual allocation made to the regional health authority, which should increase the AHA's target allocations by appropriate amounts. In the case of Buckinghamshire and Stoke Mandeville, the region has acted as indicated; indeed, the special weighting to which the hon. Member drew attention will come into effect for the 1979–80 financial year. It is up to the region to make allocations to the Buckinghamshire AHA accordingly.
The Buckinghamshire AHA will meet on 7 February to consider a report on the most recent problems arising at Stoke Mandeville. It will be for the AHA to discuss with the Oxford RHA any case for additional funding either to accelerate the programme, or to replace the hutted accommodation or implement a new programme to refurbish the building. The plans to which I have referred are within the region's current capital programme, and the fact that a good deal of work has already been put in hand clearly demonstrates that the health authorities have been aware of the need to develop and upgrade Stoke Mandeville site for some time.
The regional chairman and senior officers visited the hospital on 24 January and the regional health authority was now fully conversant with Stoke Mandeville's problems. I am confident that both the RHA and the AHA will co-operate effectively to ensure that the necessary remedial works and the new developments planned are accorded the appropriate priority within the Health Service in the Oxford region. I assure hon. Members that I share their concern for the welfare of both—

The Question having been proposed after Four o'clock, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-seven minutes to Five o'clock.